Kaohsiung Journal of Medical Sciences

Developmental Profiles of Preschool Children With Spastic Diplegic and Quadriplegic Cerebral Palsy

2010-07-01

Cerebral palsy (CP) is a disorder of movement and posture control with multiple impairments. The clinical manifestations of CP vary among children. The aim of this study was to compare the developmental profiles of preschool children with either of two types of CP: spastic diplegic (SD) CP and spastic quadriplegic (SQ) CP. Relationships between the children's various developmental functions were also investigated. We recruited 137 children with spastic CP, aged 1-5 years (mean age = 3.7 ± 2.1 years), and we classified them into two groups: SD (n = 59) and SQ (n = 78). The comparison group comprised 18 children with typical development. Developmental functions were assessed in all the children, using the Chinese Child Development Inventory with the updated norms. This scale addressed eight functional domains: gross motor ability, fine motor ability, expressive language ability, concept comprehension ability, situation comprehension ability, self-help ability, personal-social skills, and general development. A development quotient (DQ) was determined for each domain as a percentage of the developmental age divided by the chronological age. The developmental profiles of the CP subtypes were found to differ. Children with SQ were found to have lower DQs than those with SD (p < 0.01). There was also a difference in the distribution of DQs between the SD and SQ groups, although the lowest DQ in both groups was for the gross motor domain. An uneven delay in the development of gross motor function was found in both groups of children with CP. Motor functions, including gross motor and fine motor functions, were significantly related to self-help ability. Complex and significant correlations among developmental functions were also identified in children with CP. The findings in the present study may allow clinicians to anticipate the developmental profile of children with CP on the basis of whether they have the SD or SQ subtype. This, in turn, is likely to facilitate individual assessment, goal setting, and the planning of interventions in children with CP.

Endothelin-1 Enhances Superoxide and Prostaglandin E2 Production of Isolated Diabetic Glomeruli

Jia-Jung Lee, Chi-Chih Hung, Jer-Chia Tsai, Hung-Chun Chen — 2010-07-01

Endothelin-1 (ET-1) plays an important role in the pathogenic mechanism of diabetic nephropathy. However, the regulatory effects of ET-1 on superoxide and prostaglandin E2 (PGE2) in diabetic glomeruli are unclear. The aim of this study was to determine whether ET-1 exerts a differential effect on the production of superoxide and PGE2 in diabetic glomeruli. The regulatory effects of indomethacin, insulin, dexamethasone, and heparin were also investigated. Freshly isolated glomeruli were obtained from normal and streptozotocin-induced diabetic rats for 1 week (DM1W), 1 month (DM1M), and 3 months (DM3M), respectively. Our results showed that the basal superoxide production of isolated glomeruli was significantly higher in DM1M and DM3M than in the normal rats (p < 0.01). ET-1 stimulated superoxide production in normal, DM1W and DM1M glomeruli (p < 0.01) but not in DM3M rats. The basal production of PGE2 in isolated glomeruli did not differ between diabetic and normal rats. ET-1 also stimulated PGE2 production in diabetic rats (p < 0.05). Pretreatment with indomethacin further enhanced ET-1-stimulated superoxide production in all groups of diabetic rats (p < 0.05), while the ET-1-stimulated PGE2 production was attenuated by indomethacin. Insulin, dexamethasone and heparin had no additional effects on ET-1-mediated superoxide and PGE2 production. In conclusion, basal glomerular production of superoxide but not PGE2 was increased in the diabetic glomeruli. ET-1 further stimulated production of both superoxide and PGE2. Indomethacin could enhance ET-1-stimulated superoxide production while attenuating PGE2 production.

Repair of the Canine Vertebral Lamina With a Combination of Autologous Micromorselized Bone and Poly-Lactic Acid Gel After a Total Laminectomy

Jin-Peng Chuang, Chih-Peng Chang, Hung-Tau Shen, Jiun Kao, Jing-Lung Yan — 2010-07-01

The complications of a total laminectomy can include epidural scar adhesion, secondary vertebral canal stenosis and lumbar instability. The aim of this study was to assess the ability of a combination of autologous micromorselized bone and polylactic acid (PLA) gel to stimulate bone repair within canine vertebral lamina defects, as well as to prevent peridural adhesion following a laminectomy. Twenty dogs underwent a L1, L3 and L5 laminectomy after a pre-computed tomography examination. The 60 laminectomies were divided into 4 groups, and underwent the following treatments: Group A were treated with a combination of autologous micromorselized bone and PLA gel (n = 16); Group B were treated with micromorselized bone only (n = 16); Group C with PLA gel only (n = 14); and Group D were left untreated as they were the blank controls (n = 14). Vertebral laminae were harvested at 4th and 8th weeks, and examined by computed tomography and histological staining. Significant bone regeneration was observed at 4 and 8 weeks in Groups A and B, although the newly formed bone in the latter group was more irregular in shape. Spinal canal cross-sectional areas in Group B decreased as compared with those in Group A(p < 0.05), and the degree of peridural adhesion in Groups A and C was significantly lower compared with Groups B and D (p < 0.05). These findings indicate that a combination of micromorselized bone and PLA gel may provide a better strategy for the treatment of spinal stenosis.

Outcome of Physical Therapy Intervention on Ventilator Weaning and Functional Status

2010-07-01

Our study aimed to understand the characteristics of ventilator dependence in patients at a respiratory care center and the potential effects of physical therapy on ventilator weaning and patients' functional status. Prospective data collection consisted of the following: (1) demographic data, including name, gender, age, diagnosis, the Acute Physiology and Chronic Health Evaluation as a severity of the disease, modified Glasgow Coma Scale, mobility at the time of admission, and days of hospitalization; (2) Rapid shallow breathing index (RSBI) as a predictive indicator of ventilator weaning, including indicators of ventilator weaning were collected from the respiratory flow sheet; and (3) Barthel index. Between July 1 and December 31, 2007, 126 patients were admitted to the respiratory care center, and those who required mechanical ventilation for more than 14 days were enrolled. Fifty-five subjects received physical therapy. The RSBI in patients who received physical therapy was 75.7 ± 37.9 before therapy and 80.0 ± 48.5 afterwards, while the Barthel index increased from 0.8 ± 1.4 to 1.9 ± 2.5 (p < 0.05). The RSBI decreased as time of physical therapy lengthened, but not significantly (r = 0.12, p = 0.44). The success rate of ventilator weaning in patients receiving physical therapy intervention versus non-physical therapy intervention was 58.2% and 40.9%, respectively. The results indicated that lengthening the physical therapy intervention time enhanced the ventilator weaning success rate while mobility was not affected (r = −0.11, p = 0.41). Physical therapy may be offered to ventilator-dependent patients in line with their individual needs to improve or maintain basic mobility.

Toxoplasma IgG Expressed in a Patient With Rosai-Dorfman Disease

Hung-Ju Liao, Ching-Wen Chiang — 2010-07-01

Rosai-Dorfman Disease (RDD) is a rare benign disease characterized by sinus histiocytosis with massive lymphadenopathy. RDD can be differentiated from other types of histiocytosis by immunochemical analysis, as RDD is positive for S100. Conversely, toxoplasmosis lymphadenitis is characterized by clusters of epithelioid histiocytes in lymphoid tissue, with mixed lymphocytic and immunoblastic cell populations. The serology data could help in diagnosing toxoplasmosis lymphadenitis, as the toxoplasma IgG should be positive. Here we present the rare case of a 73-year-old woman who presented with a left parotid mass and multiple neck lymphadenopathy that initially had been diagnosed as toxoplasmosis lymphadenitis from a positive result on serology examination, but was finally proven to be RDD based on immunochemical results. We also discuss the relationship between RDD and toxoplasmosis in this case.

Recurrent Factitious Subcutaneous Emphysema: Report of a Complex Case in a Young Woman and a Literature Review

Yi-Pei Lee, Julia Yu-Yun Lee — 2010-07-01

Subcutaneous emphysema (SE) can be caused by antecedent trauma, surgery, rupture of visceral organs or serious infection from gas-forming microorganisms. Factitious SE is very rare; only about a dozen cases have been reported. Most patients had an underlying psychiatric condition or relevant history. The diagnosis and management of factitious SE are challenging. We report a new case of factitious SE with a very complex clinical course. A 29-year-old woman was seen at consultation for recurrent attacks of painful soft tissue swelling, affecting her chest wall, abdomen and neck over several months. Factitious disease was suspected because of the negative medical history of identifiable visceral perforations or gas-forming infections and the presence of multiple bizarre linear scars on the arm. This was supported by finding multiple recent puncture marks on the neck, chest and upper extremities on close inspection. The patient's history was remarkable for multiple stressful events in her life, frequent job changes, substance abuse and suicide attempts. Psychiatric evaluation revealed adjustment disorder with depression and anxiety, cluster B personality with bipolar II disorder and substance abuse. During the 1-year period, she had 20 visits to our ER for attacks of SE affecting various parts of her body. This case illustrates that self-infliction should be suspected in a patient presenting with medically unexplained recurrent SE and a hollow history, and one should search for puncture marks to support the diagnosis.

Acute Myocardial Infarction With Simultaneous Involvement of Right Coronary Artery and Left Anterior Descending Artery: A Case Report

2010-07-01

Acute myocardial infarction is usually caused by rupture of unstable plaque and involves a single coronary artery. Simultaneous occlusions of multiple coronary arteries in patients with ST elevation myocardial infarction are uncommon and lead to a fatal outcome. We report a 75-year-old male presenting with persistent chest pain complicated by ventricular fibrillation. After defibrillation and cardiopulmonary resuscitation, an emergency coronary angiogram showed total occlusion of the right coronary artery, and thrombus in the proximal left anterior descending artery. Both coronary arteries underwent successful balloon inflation and stenting. The patient finally survived under ventilatory support. This rare case suggests that aggressive reperfusion therapy and even mechanical support to improve poor clinical outcome are suggested in high risk patients with multivessel occlusions.

Alveolar Hemorrhage After Scuba Diving: A Case Report

2010-07-01

Self-contained underwater breathing apparatus (scuba) diving is increasingly popular in Taiwan. There are few references in the literature regarding pulmonary hemorrhage as the sole manifestation of pulmonary barotrauma in scuba divers, and no study from Taiwan was found in the literature. We present the case of a 25-year-old man who suffered alveolar hemorrhage related to pulmonary barotrauma as a complication of scuba diving. To our knowledge, this is the first case report describing a Taiwanese subject suffering from non-fatal pulmonary hemorrhage after scuba diving.