11/45. Aplasia of the right lung in a 4-year-old child: surgical stabilization of the mediastinum by diaphragm translocation leading to complete recovery from respiratory distress syndrome. lung aplasia is defined as unilateral absence of the lung with preservation of main bronchus remnant at the tracheal bifurcation. patients usually die soon after birth and there is no specific therapy for this condition, as evidenced by the literature. The authors present a case of an infant that was asymptomatic with this malformation until 3 months of age, when the child had respiratory distress syndrome. Subsequently, lung aplasia was diagnosed. The authors performed an extrapleural dissection and cephalad translocation of diaphragm to reduce the mediastinal shift and heart rotation, to relieve a kink and compression of the trachea by the aortal arch and truncus arteriosus, as well as to relieve hyperinflation of lung parenchyma and provide recovery from respiratory distress syndrome. This new approach resulted in complete recovery from respiratory distress syndrome and full tolerance of physical exercise. The child underwent follow-up for 4 years. Diaphragmatic translocation may be useful in treatment of respiratory disorders associated with lung aplasia. ( info) |
| In April 1999, a previously healthy 22-year-old woman was taken ill with fever and bilateral swelling of the parotid glands. A chronic course of disease extending from April to December was found with swelling of the parotid glands, fatigue, low grade fever, episodes of tachycardia and nightswetting. mumps virus rna of genotype A character based on the SH (small hydrophobic) protein gene classification was demonstrated in three serum samples collected during the course of clinical disease. Different criteria for reinfection were fulfilled including demonstration of IgG antibodies by ELISA in a preinfection serum sample. The preinfection serum sample of the patient was able to efficiently neutralize the infectivity of a heterologous genotype D strain but was unable to neutralize the homologous genotype A virus. The findings in the present study may offer an explanation of a mechanism behind previously observed vaccine failures and the occurrence of reinfection with heterologous mumps virus strains. ( info) |
13/45. "Simply to be let in": inclusion as a basis for recovery. This article takes its inspiration from a poem by Borges, in which the author makes a plea to simply be "let in" without being wondered at or required to succeed. Based on the view that these issues have applied historically to people with mental illnesses--first during the period of the asylum, and now more recently as a result of deinstitutionalization--this article argues for the adoption of a broad conceptual framework of inclusion that, based on a disability paradigm, neither alienates or requires people to succeed. First, the ways in which such a framework augments existing approaches to treatment, rehabilitation, and recovery are outlined. Next, the authors describe the three elements of friendship, reciprocity, and hopefulness as aspects of inclusion that may provide a foundation for efforts toward recovery, and illustrate each of these elements through the stories of participants in a supported socialization program. Implications for future research and policy are suggested based on these data. ( info) |
14/45. Ethical concerns in isolating patients with methicillin-resistant Staphylococcus aureus on the rehabilitation ward: a case report. Concern about methicillin-resistant staphylococcus aureus (MRSA) is increasing in rehabilitation facilities. Those affected are often isolated to prevent the spread of MRSA to other patients. Because this isolation often interferes with the traditional rehabilitative approach, rehabilitation team members find themselves in an ethical dilemma as to how to approach these patients. Some patients may feel that strict isolation protocols violate their rights. We report a case showing the ethical dilemmas that an MRSA-positive patient brings to the rehabilitation setting. Isolation techniques make it difficult to treat rehabilitation patients using the current standards of care without compromising the medical ethics principles of autonomy and beneficence. Further study is required to establish protocols for patients with MRSA in the rehabilitation setting. ( info) |
15/45. Psychological management of the myocardial infarction patient. The acute coronary experience is divided into three parts. In the first, the pre-hospital phase, attention is devoted to the widespread phenomenon of patient delay. Evidence is given to indicate that the source of delay is entirely psychological and centers around the inability to decide whether or not to seek help. The second part, or hospital phase, describes the response of the patient to the various aspects of the coronary care unit, including monitoring, false alarms, witnessing and sustaining a cardiac arrest. The third phase, the post-hospital convalescence, centers on the principal psychological problem of this period, depression. Its causes, manifestations, and methods of management are discussed. ( info) |
| In March 2003, an outbreak of severe acute respiratory syndrome started in hong kong. A 57-year-old woman had a typical presentation, including fever, non-productive cough, malaise, lymphopenia, and raised liver aminotransferases. The clinical course and successful treatment with convalescent plasma, ribavirin, and corticosteroids are discussed. ( info) |
17/45. severe acute respiratory syndrome (SARS): imaging findings during the acute and recovery phases of disease. severe acute respiratory syndrome (SARS) is a new form of atypical pneumonia, which has become a major health crisis in East Asia and canada, with the potential for becoming the next worldwide epidemic. Until the validation of diagnostic kits is completed, clinical findings, contact history, and radiologic findings are the key to diagnosis of this disease. The imaging findings on conventional radiographs and computed tomography (CT) in the acute phase as well as during recovery are presented. ( info) |
18/45. Delayed regeneration of foveal cone photopigments in Vogt-Koyanagi-Harada disease at the convalescent stage. PURPOSE: To evaluate the physiological characteristics of the macula in patients with Vogt-Koyanagi-Harada disease during the convalescent stage with specific reference to the kinetics of foveal cone photopigment regeneration. methods: Six eyes of three patients at the convalescent stage of Vogt-Koyanagi-Harada disease were studied. All the eyes had best corrected visual acuity of 1.0 or better and had had no recurrence of inflammation for at least 12 months after the last episode. Foveal cone densitometry (FCD), focal macular electroretinograms, color vision tests, two-color perimetry, and optical coherence tomography (OCT) were performed. RESULTS: No regeneration of cone photopigments was detected within the 7-minute testing time by FCD in all eyes at the first examination after the last episode. However, the other functional tests were normal, and the OCT-determined macular morphology was also normal. The regeneration kinetics of the foveal cone photopigment improved in three of six eyes at 36, 37, and 19 months after the last episode, whereas the other three remained delayed at 18, 18, and 49 months. CONCLUSIONS: These findings suggest that a disorder of the foveal cone photopigment regeneration, and its recovery, requires a significantly longer time than that of other macular functions in some patients with Vogt-Koyanagi-Harada disease. ( info) |
| Leigh's disease is a mitochondrial disease of infancy and early childhood, and is rare in adults. Following a febrile illness, a 21-year-old woman developed ataxic paraparesis and was originally diagnosed as multiple sclerosis. Her illness progressed to somnolence and quadriparesis. The unusual MR images, the discovery of elevated blood lactate and pyruvate levels, the results of muscle biopsy and the lack of response to corticosteroid treatment, led to the correct diagnosis of leigh disease. Initiation of a ketogenic diet resulted in a rapid partial response. She recovered sufficiently to be able to walk after 6 months. ( info) |
20/45. Functional MRI follow-up study of language processes in healthy subjects and during recovery in a case of aphasia. BACKGROUND AND PURPOSE: The goal of this study was to develop a functional MRI (fMRI) paradigm robust and reproducible enough in healthy subjects to be adapted for a follow-up study aiming at evaluating the anatomical substratum of recovery in poststroke aphasia. methods: Ten right-handed subjects were studied longitudinally using fMRI (7 of them being scanned twice) and compared with a patient with conduction aphasia during the first year of stroke recovery. RESULTS: Controls exhibited reproducible activation patterns between subjects and between sessions during language tasks. In contrast, the patient exhibited dynamic changes in brain activation pattern, particularly in the phonological task, during the 2 fMRI sessions. At 1 month after stroke, language homotopic right areas were recruited, whereas large perilesional left involvement occurred later (12 months). CONCLUSIONS: We first demonstrate intersubject robustness and intrasubject reproducibility of our paradigm in 10 healthy subjects and thus its validity in a patient follow-up study over a stroke recovery time course. Indeed, results suggest a spatiotemporal poststroke brain reorganization involving both hemispheres during the recovery course, with an early implication of a new contralateral functional neural network and a later implication of an ipsilateral one. ( info) |