ABSTRACT
We report about 38 patients aged between 1 and 19 years (36.8% female, 63.2% male; mean age 7.8 years) admitted as inpatients for further neurorehabilitation mostly 4 weeks after severe acquired brain injury (ABI) of different aetiology. Of the patients, 73.7% were in a state of minimal responsiveness (vigilance score < 7 WVS) on admission. We evaluate the course of rehabilitation and the outcome 6 months after the end of the inpatient-period. The average stay of 15.5 weeks is strikingly low. The average intensity of therapy comes to about 16 units per week including strategies of rehabilitative education. The incidence of good rehabilitation was 21%, whereas almost 45% of patients displayed severe impairment. Although further improvements were found in almost 40% of patients 6 months later, these only slightly changed the overall picture of the GOS values. More than 3/4 returned to their families after rehabilitation, often despite great functional impairment. A return to the former environment outside the family (kindergarten, school) was, however, possible in 2/3 of the subjects. The proportion of minimally responsive patients fell from 73.7% to 18.4% during the stationary rehabilitation phase. After a further 6 months (follow up), 36.4% of the originally minimally responsive patients achieved a GOS value of > 5.
Subject(s)
Brain Injuries/rehabilitation , Adolescent , Adult , Arousal/physiology , Brain Injuries/etiology , Brain Injuries/physiopathology , Child , Child, Preschool , Education, Special , Family Relations , Female , Follow-Up Studies , Glasgow Coma Scale , Hospitalization , Humans , Incidence , Infant , Length of Stay , Male , Patient Discharge , Social Environment , Treatment OutcomeABSTRACT
Based on a phenomenological analysis of psychotic interpretation of the world concretism is supposed to represent an important mechanism of schizophrenic thinking: Schizophrenic concretism is the result of an ontological regression of cognitive functioning onto the archaic level of actional representation. Following Jean Piaget's theories about the children's constructions of reality a hypothesis about the structure of psychotic interpretations of the world is being proposed: In psychotic thinking the knowledge about the world is structured in an adualistic way which is characterized by an alloy of significance and notion, inner and outer world, physis and psyche. The structural similarity of psychotic thinking and thinking in early developmental stages is illustrated concretely on the basis of examples. Fundamental differences between childish and schizophrenic ways of interpreting the world will be presented, showing the specificity of cognitive representation in schizophrenic thinking.
Subject(s)
Personality Development , Schizophrenia/diagnosis , Schizophrenic Psychology , Social Perception , Thinking , Defense Mechanisms , Humans , MagicABSTRACT
The problematic nature of the description of children and adolescents with deviating behavior becomes evident by the short representation of the pathways of three patients. The critical discussion of the "usual" way to speak during psychiatric every-day-life uncovers patterns of speech--inducing on the one side according to their own dynamics the labeling process and on the other side a fixation of the team in a "stigmatisierendes Beurteilungssyndrom" (rating-syndrome).
Subject(s)
Attitude of Health Personnel , Child Behavior Disorders/psychology , Stereotyping , Adolescent , Aggression/psychology , Child , Humans , Verbal BehaviorABSTRACT
Tuberous sclerosis was diagnosed in 21 patients (13 female, 8 male) at an age of 3 months to 17 years, 8 of them being younger than 1 year at the time of diagnosis. 14 cases occurred sporadic, 7 patients had a positive familial history of the disease. The diagnosis was based on typical cutaneous lesions (white spots in 19, adenoma sebaceum in 12), cerebral seizures (20 patients) and intracranial calcifications which were found in all 17 patients who were investigated by cranial computerized tomography, especially in all 5 patients who were investigated in the first year of life. In addition two patients showed tumors arising from the region of the frontal horns. Histological examination which was performed in one of them showed the typical picture of a subependymal giant cell astrocytoma. Seizures occurred within the first year of life in 15 of 20 patients. The most common seizure type were infantile spasms (11 patients), grand mal (10 patients) and partial seizures (7 patients). In two children Todd's palsies were observed. Mental retardation of variable degree was observed in 11 patients. Cystic renal lesions were found in one patient with severe haematuria and they were suspected in 3 others on ultrasonographic examination. Retinal phakoma was found in only one patient, cardial rhabdomyoma was suspected in another one who suffered from congenital multifocal atrial tachycardia. The diagnosis in the first year of life was based upon the typical trias of white spots, seizures and intracranial calcifications on CT examination.
Subject(s)
Brain/pathology , Sclerosis/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Age Factors , Child , Child, Preschool , Electroencephalography , Female , Humans , Infant , Male , Skin/pathologyABSTRACT
Following an influenza-like illness four patients developed severe pains in the calf muscles. All patients showed elevated levels of serum-creatinin-phosphokinase (CPK) and Coxsackie-B-virus-titers; with the exception of electromyographic abnormalities the other laboratory findings were normal. Because of the diagnosis, myalgia cruris epidemica, only symptomatic treatment was performed. Differential diagnostic and aetiological aspects are discussed.
Subject(s)
Coxsackievirus Infections/complications , Leg , Muscular Diseases/etiology , Pain/etiology , Blood Sedimentation , Child , Coxsackievirus Infections/diagnosis , Coxsackievirus Infections/enzymology , Creatine Kinase/metabolism , Electromyography , Humans , Male , Transaminases/metabolismABSTRACT
We present two patients with symptoms typical of Poland's Syndrome: unilateral hypoplasia of the pectoral muscle and dysplastic anomalies of the ipsilateral upper limb. Additionally skeletal and G.U. tract abnormalities can be found. One of our cases shows stenosis of the ureterovesical junction which led to hydronephrosis and dilation of the ureter; in the other case the ventral portions of the 3rd and 4th right ribs are missing.
Subject(s)
Arm/abnormalities , Muscles/abnormalities , Humans , Hydronephrosis/complications , Infant , Male , Ribs/abnormalities , Syndrome , Ureter/abnormalitiesABSTRACT
Lower respiratory infections in infancy caused lung emphysema in a 10-year old girl; being a locus minoris resistentiae the emphysema led to recurrent pulmonary complaints. This corresponds to the definition of the Swyer-James or McLeod Syndrome. The radiologic clue to the diagnosis is often the "unilateral hyperlucent lung", which is also found in many other childhood diseases. With our case we present an economical way of differentially diagnosing the unilateral hyperlucent lung, a way that is as little invasive as possible.
Subject(s)
Lung Diseases/diagnostic imaging , Bronchography , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Pulmonary Emphysema/complications , SyndromeABSTRACT
1008 Bantu and 295 Nilotes of Kenya were tested with regard to protanopia-deuteranopia by means of the ISHIHARA-Plate No. 11 (16 plates edition). Four (0.55%) of the male Bantu and two (1.03%) of the male Nilotes showed a partial or total red-green-blindness. With the females of these samples no case of defective colour vision was observed.
