Asylum-seeking children with severe loss of activities of daily living: clinical signs and course during rehabilitation.

AIM: To investigate whether severe loss of activities of daily living (ADL) in asylum-seeking children is associated with physical disease or toxic influences and to describe the clinical course during the recovery process. METHODS: A total of 29 asylum-seeking children with severe loss of ADL were regularly assessed by physical examinations, laboratory tests and a structured evaluation of their ADL status during rehabilitation. RESULTS: A total of 12 children had previously recorded suicide attempts and 21 were recorded to have experienced traumatic events in their country of origin. The mean time from turning point to recovery was 6 months. Of the study participants, 22 needed enteral feeding and 18 gained weight during recovery. All children had a pulse rate and systolic blood pressure within the normal range. No sign of intoxication or physical disease was identified in laboratory tests or clinical examinations, with the exception of one case of epilepsy. CONCLUSION: Physical disease, pharmacological sedation or anorexia nervosa was not considered to be a probable cause of the loss of ADL in these children. The high rate of psychosocial risk factors and the stressful event of being in an asylum-seeking process call for further investigation of psychosomatic mechanisms.

[School maladjustment common among children with very low birth weight Special attention and support are required during school start]. / Skolsvårigheter vanliga hos barn med mycket låg födelsevikt. Extra uppmärksamhet och stöd behövs vid skolstart.

Children of very low birth weight (VLBW), defined as less than 1500 g, and normal birth weight controls (NBW) were enrolled in a long-term follow-up study. Five of 86 surviving VLBW children had a neurological handicap. Seventy VLBW children and 72 NBW children were re-examined at the age of nine, which entailed a neurological examination, a non-verbal intelligence test and a test for reading ability, mathematical skills and vocabulary. Their behavior was rated regarding hyperactivity, social behavior and fine and motor skills. The two groups differed with regard to the neurological examination and the tests, with poorer results shown for the low birth weight group. The VLBW children were also more hyperactive and scored lower on fine motor skills. Considering only those who scored normally as regards non-verbal intelligence (54% of VLBW children and 88% of controls), practically all differences disappeared.

A comparative study of anorganic xenogenic bone and autogenous bone implants for bone regeneration in rabbits.

The aim of this study was to investigate the possible use and ultimate fate of anorganic xenogenic bone for the restoration of defects in the maxillae and mandibles of adult rabbits. Furthermore, anorganic xenogenic bone was compared with implanted autogenous bone particles with regard to the response of the surrounding connective tissue and possible resorption of these implants by multinucleated cells. Results showed that after 12 weeks, the implanted autogenous bone was actively resorbed by multinucleated cells, and new bone was formed in close apposition to the particles. In contrast, implanted anorganic xenogenic bone was degraded to a much lesser extent, and new bone was seen adjacent to the anorganic bone particles without signs of resorption. Further long-term studies are needed to determine whether anorganic xenogenic bone may be regarded as a resorbable material and whether any side effects occur as a result of this material's tendency to linger on in the recipient bed.

Measurement of quadriceps muscle strength and bulk in juvenile chronic arthritis. A prospective, longitudinal, 2 year survey.

OBJECTIVE: In a prospective survey over a 2-year period we studied strength and bulk of the quadriceps muscle in the thighs of children with juvenile chronic arthritis (JCA). METHODS: Every third month for 2 years we measured isometric muscle strength in knee extensors with a hand-held dynamometer in 20 children with JCA. Ultrasound equipment was used to measure thigh muscle bulk. A joint evaluation was made using a standard severity score. The children had their ordinary medical treatment and physiotherapy during the observation period. RESULTS: Children with high severity scores in the knee or hip had least strength and muscle bulk. In the 4 children with the highest severity scores muscle strength was reduced to half of that expected. In 10 of the children there were clear variations in severity scores during the study period, for either better or worse. In these children an increase in the severity score correlated significantly with reduction in muscle strength and bulk (p < 0.05). The muscle strength and bulk changed in parallel in these children. Other factors, although not independent, such as polyarticular JCA, long duration of disease, and steroid treatment, also reduced muscle strength. CONCLUSION: The presence and intensity of local arthritis is one important factor affecting muscle function in JCA. Normal muscle strength and bulk is rapidly lost near an inflamed joint. It is difficult to maintain or achieve normal muscle function in the presence of active arthritis despite medical and physical treatment. We assume that the muscle weakness is in part caused by atrophy of the muscle, which is influenced by local arthritis.

Antiepileptic drug-related cognitive complaints in seizure-free children with epilepsy before and after drug discontinuation.

The cognitive complaints reported by children and their parents, as subjectively associated with antiepileptic drug (AED) treatment, were evaluated in seizure-free children before and after drug discontinuation. The aim of the design was to isolate the cognitive side effects of AEDs from other factors, such as the effect of seizures. Our inventory explored the following areas: "alertness," "concentration," "activation/ tiredness," "memory," "drowsiness," "depression," "aggressiveness," and "hyperactivity," using a 5-point Likert scaling procedure. One hundred two eligible patients were selected, each matched with a healthy control and assessed when still on antiepileptic medication. All children were seizure free for at least 1 year. The medication was then discontinued gradually over a 3-month period. Four months after the children were completely medication free, a second assessment was carried out, but only in the 83 children who remained seizure free and in their matched controls. The results of the reports made by the children themselves did not show differences with the matched controls, and only showed improvement after drug discontinuation for complaints about "tiredness." Parents of the children with epilepsy reported significant improvement in all areas related to "alertness and activation" after discontinuation of the drugs. The finding that only a limited number of children have cognitive complaints, both when still on AEDs and after discontinuation, may be in line with the reports that the major factor contributing to quality of life is whether patients are seizure free or still have seizures. All patients in this study were seizure free for a period >1 year, which may have caused the favorable pattern of response in our patient group.

Morbidity and neurological function of very low birthweight infants from the newborn period to 4 y of age. A prospective study from the south-east region of Sweden.

All 107 infants weighing < or = 1500 g at birth (VLBW) and born alive in the south-east region of Sweden during a 15-month period in 1987-88 were enrolled in a prospective study to determine the prevalence of handicap and to assess neurological function in comparison with controls. Eighty-six (80%) infants survived. Twenty (19%) had intracranial haemorrhages (ICH) assessed by ultrasound examinations in the neonatal period and 2 (2.3%) retinopathy of prematurity stage 3 or more. The VLBW infants who survived had fewer optimal neurological responses than the controls at 40 weeks post-conceptional age. Eighty-two VLBW children were followed to 4 y of age. Three (4%) children had a neurological handicap and 9 (11%) had a moderate neurological deviation. Neither the size of ICH nor neonatal optimality score correlated to neurological outcome at 4 y of age. The VLBW children without neurological handicap or deviation (n = 70) had a delay in psychomotor development in comparison with the controls. Mental development and school performance, in particular language development, will be examined at school age.

Relationship between apical and marginal healing in periradicular surgery.

OBJECTIVE: The purpose of the present study was to evaluate the relationship between apical and marginal periodontal healing after periapical surgery. STUDY DESIGN: The investigation was conducted on 59 patients referred for periradicular surgery. A radiographic examination as well as assessments of periodontal attachment and pocket depth of teeth undergoing surgery and control teeth were performed at the time of surgery and 1 year after surgery. The radiographic periapical healing pattern was evaluated. RESULTS: After an observation time of 1 year, 85% of the healing patterns were classified as successful or uncertain. Teeth within the surgical area showed a significant loss of clinical attachment during the observation period. The mean clinical attachment loss in teeth with an unsuccessful healing was 0.85 mm and differed significantly from successfully healed cases (mean, 0.15 mm). CONCLUSIONS: A persisting endodontic infection may be regarded as a contributing risk factor for a progressing marginal attachment loss.

[Good prognosis for very low birth weight infants]. / God prognos för barn med mycket låg födelsevikt.

A population-based multicentre study, comprising all very low birthweight (VLBW; < or = 1,500 g) infants born alive in the south-east region of Sweden during a 15-month period, was performed in the late 1980s. Among the VLBW infants there were 107 lifebirths (a rate of 0.72%), 86 (80.4%) neonatal survivors and no late deaths. Twenty (18.4%) had intracranial complications, two (2.3%) retinopathy of prematurity, grade 3, and six (5.6%) bronchopulmonary dysplasia. At follow-up at 18 months of uncorrected age, the VLBW infants were still lighter in weight and of shorter stature than control group infants. Of the five (5.8%) of the surviving VLBW infants who had significant neurological disorder at 18 months of age, all had weighed less than 800 g at birth, and had manifested neurological symptoms at 6 months of age. The hospitalisation rate during the first 18 months of life was greater in the VLBW than the control group.

Neurosensory disturbances of the trigeminal nerve: a long-term follow-up of traumatic injuries.

PURPOSE: This study assesses the physical and psychosocial consequences of trigeminal nerve damage. MATERIAL AND METHODS: A questionnaire consisting of 33 questions, 30 of which had fixed alternatives, was mailed to 300 persons who had received compensation from a syndicate of several insurance companies (Konsortiet för Patientförsäkring) because of trigeminal nerve damage. One question with no alternative reply gave the respondents an opportunity to comment on their problems and to rate them on a visual analogue scale. The questionnaire was answered by 226 recipients, 72 men and 153 women. RESULTS: Most of the patients had sensory disturbances resulting from damage to the inferior alveolar nerve, the mental nerve, or the lingual nerve. More than 70% of the respondents complained about paresthesia. No fewer than one of five patients suffered from pain in the affected area. The altered sensation caused functional disturbances in speech and eating which, in turn, had social and psychological consequences. CONCLUSIONS: This study shows that mainly women and older persons have the most severe discomfort after oral nerve damage.

Replacing carbamazepine slow-release tablets with carbamazepine suppositories: a pharmacokinetic and clinical study in children with epilepsy.

A suppository for rectal administration of carbamazepine has been developed for situations in which it is unsuitable to use the oral route of administration. In an open, controlled, within-patient study, the pharmacokinetics, clinical efficacy, and tolerability of carbamazepine slow-release tablets were compared with those of carbamazepine suppositories in children with epilepsy. The pharmacokinetic part of the study comprised 22 children, and an additional nine children were included in the clinical part of the study. Treatment with slow-release tablets was replaced for 7 days with carbamazepine suppositories in bioequivalent dosage. Clinical factors such as the rate of seizures and the local tolerability were studied, and an overall assessment of efficacy was made. In the pharmacokinetic part, 24-hour plasma concentration curves for carbamazepine and carbamazepine-10,11-epoxide were recorded. The plasma concentration profiles (minimum, maximum, and mean concentrations, fluctuation index, and area under the curve) for carbamazepine and the other metabolites did not show any significant differences between oral and rectal administration when the suppository dose was increased by 25% compared to the tablets. No increase in seizure frequency was detected, and the overall assessment was very good to good in 25 of the 29 epileptic children. Increased flatulence during treatment with suppositories was noted in two children, one had anal irritation, and one had nausea/vomiting. Treatment with carbamazepine slow-release tablets in children with epilepsy can be replaced by carbamazepine suppositories in 25% higher dosage, with good clinical effect and appropriate pharmacokinetic values, when it is unsuitable to use the common oral route of administration.

Withdrawal of antiepileptic medication in children. Correlation of cognitive function and plasma concentration--the multicentre 'Holmfrid' study.

Eighty-three patients with epilepsy and 83 matched controls completed 12 computerized cognitive tests while on antiepileptic drugs and six months later when they had been medication-free for three to four months. All patients had been seizure-free for more than one year and were on monotherapy with carbamazepine (CBZ, n = 56), valproate (VPA, n = 17), or phenytoin (PHT, n = 10). The tests and plasma concentration collection were done at noon. The mean peak plasma concentrations in the CBZ patients were as follows: 31% below 30 mumol/l, 48% between 30 and 42 mumol/l and 21% above 42 mumol/l. No difference in performance could be detected between the groups. One significant correlation between plasma concentration and test results was found. The mean VPA concentration was 625 mumol/l (S.D. 189). A tendency towards a weak negative correlation between test results and plasma concentration was present. The PHT patients' therapeutic range had a mean concentration of 32.0 mumol/l (S.D. 18.5). One significant correlation between a memory test and plasma concentration could be detected. Overall, the patients in the different antiepileptic groups performed less good than the control group and in a few cases the differences were statistically significant when compared either before or after withdrawal. A comparison of the changes after withdrawal showed improvement in the majority of tests, but these changes were also present in the matched control group.

Withdrawal of antiepileptic medication in children--effects on cognitive function: The Multicenter Holmfrid Study.

We present 100 children diagnosed with epilepsy who were seizure-free for more than 1 year and still on monotherapy of antiepileptic drugs (AEDs). We matched each child with a healthy classmate and performed neuropsychological testing and EEG before and after complete withdrawal of the AEDs. The withdrawal phase lasted 3 months, but the dose decrease was individualized for each patient. Three to 4 months after complete withdrawal of the drug all patients were reassessed. Patients with seizure relapse are excluded from the study. Seventeen patients are regarded as dropout, 11 because of seizure relapse and six because of protocol violation. The remaining 83 patients were treated with carbamazepine (n = 56), valproic acid (n = 17), or phenytoin (n = 10). Serum concentrations of the AEDs were measured using peak plasma levels that were taken immediately before or after psychological testing. We used neuropsychological tests to assess psychomotor function and "central" cognitive processing such as information processing or memory function. We found significant improvement attributable to drug withdrawal on only one of the cognitive tests, namely, psychomotor speed, suggesting that the impact of AED treatment on higher-order cognitive function is rather limited. In addition, we found group differences between the epilepsy group and the control group at baseline that persisted after drug withdrawal. Subsequent analysis showed some factors that may have contributed to these group differences. First, patients with a former diagnosis of absence seizures show lower scores both at baseline and after drug withdrawal. We may assume that the seizure propensity has not disappeared completely in these patients. Some evidence is found that phenytoin may have a different cognitive profile than carbamazepine, with more impairment on tests that measure motor and mental speed. Again, this impairment persists after drug withdrawal.

The importance of leg support for relaxation of the pelvic floor muscles. A surface electromyograph study in healthy girls.

The ability of relaxation is a necessary component for a good function of the pelvic floor muscles (PF). The importance of a relaxation technique for the PF has not been paid much attention in children either in urological examinations or treatments. The aim was to seek postures with optimal relaxation of the PF for use in clinical practice with girls. The relaxation of the PF and adjacent hip and abdominal muscle groups was studied by using surface electromyography (EMG) and a polygraph writer in 20 healthy volunteer girls, 6 and 10 years of age. They were placed in three different postures with their legs supported and unsupported. In postures with supported legs, the relaxation was observed in 94% recorded from the PF and in 97% from the adjacent muscles. EMG amplitudes from the PF and adductor muscles were significantly higher in postures with unsupported legs compared to postures with supported legs (p less than 0.05). The present study indicates that the optimal relaxation of the PF can be achieved by adequate leg support. This can be important to apply particularly in clinical situations such as urodynamic investigations, in uro-biofeedback training and for the design of pelvic floor exercises for girls.

Discontinuation of antiepileptic drugs in children who have outgrown epilepsy: effects on cognitive function.

Cognitive function is frequently impaired in children with epilepsy, compared with age-matched controls. It can be hard to evaluate the significance of various contributory factors. The effects of antiepileptic drugs may be studied in children who have outgrown their epilepsy but are still being treated. A multicenter study to assess various aspects of cognitive function in children with different forms of epilepsy, both during and after treatment with antiepileptic drugs, is currently under way. Definitive results are not yet available; interim analysis of the findings suggests that short-term memory is decreased in all subgroups of children being treated for epilepsy, compared to controls.

Experiences of rocket seat ejections in the Swedish Air Force: 1967-1987.

From 1967 to 1987 there were 83 successful and 9 fatal ejections with Saab rocket seats in the Swedish Air Force. Medical consequences and injury factors are reviewed. Thirty-nine survivors had nontrivial injuries; four were seriously injured. The risk for injury has been approximately 50% throughout the period. Two-thirds of the survivors resumed flying within a week, the remainder after up to 1 year, except for three pilots who terminated their flying status.

Surface electromyography of pelvic floor muscles in healthy children. Methodological study.

Pelvic floor muscle activity was recorded in ten healthy children, aged six to ten years, by using surface electromyography and a polygraph writer. The electromyograms were recorded simultaneously from four electrode pairs on the perineum and three electrode pairs on adjacent muscle groups, i.e. hip and abdominis muscles. The children performed ten different manoeuvres. Necessary prerequisites for this investigatory method include good electrode application, adequate instruction of the child and the child's adjustment to the method. Using the described procedure, it was possible to record pelvic floor muscle activity without any appreciably detectable electrical influence from adjacent muscles. The method sometimes allows selective recording of electromyographic activity between the ventral urogenital and the dorsal anal regions. Therefore both anal and urethral electrode pairs should be used to achieve functional information about the pelvic floor muscles. The envisaged method should be useful as a tool for assessment of pelvic floor muscle exercises in children with voiding disorders.