Stability of vocational outcome in adulthood after moderate to severe preschool brain injury

2004 ◽  
Vol 10 (5) ◽  
pp. 719-723 ◽  
Author(s):  
TAINA NYBO ◽  
MARKKU SAINIO ◽  
KITI MÜLLER
Keyword(s):  
Brain Injury ◽  
Neuropsychological Tests ◽  
Daily Living ◽  
Traffic Accidents ◽  
Work Status ◽  
Full Time ◽  
Vocational Outcome ◽  
Time Work ◽  
The Mean

We studied how moderate to severe childhood traumatic brain injury (TBI) affects vocational outcome with time. This is the second follow-up of patients who were injured as preschoolers in traffic accidents. In the first follow-up the mean age was 23 years and in the present study the average age of the 27-patient cohort was 40 years. Twenty-two patients were assessed clinically by a neuropsychologist, neurologist and a social worker. Five patients, although not able or willing to participate in the clinical study, were contacted by telephone and interviewed on their vocational outcome. Compared to the first follow-up, 20/27 patients in total had no change in their vocational status. Nine out of the 27 patients were working full-time, two had subsidized jobs and 16 were not working. Twenty-four of 27 patients were independent in daily living. In the neuropsychological tests of executive functions, preserved flexibility associated with full-time work status. In conclusion, 1/3 of the patients were still employed full-time over 30 years after the TBI. This suggests that favorable vocational outcome, reached by young adulthood, is maintained at least until middle age. (JINS, 2004,10, 719–723.)

Adult outcome after treatment of pediatric posterior fossa ependymoma: long-term follow-up of a single consecutive institutional series of 22 patients with more than 5 years of survival

2020 ◽  
Vol 26 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Tryggve Lundar ◽  
Bernt Johan Due-Tønnessen ◽  
Radek Frič ◽  
Petter Brandal ◽  
Paulina Due-Tønnessen
Keyword(s):  
Proton Beam ◽  
Posterior Fossa ◽  
Adjuvant Treatment ◽  
Tumor Control ◽  
Full Time ◽  
Time Work ◽  
Long Term Follow Up ◽  
Long Term Survivors

OBJECTIVEEpendymoma is the third most common posterior fossa tumor in children; however, there is a lack of long-term follow-up data on outcomes after surgical treatment of posterior fossa ependymoma (PFE) in pediatric patients. Therefore, the authors sought to investigate the long-term outcomes of children treated for PFE at their institution.METHODSThe authors performed a retrospective analysis of outcome data from children who underwent treatment for PFE and survived for at least 5 years.RESULTSThe authors identified 22 children (median age at the time of surgery 3 years, range 0–18 years) who underwent primary tumor resection of PFE during the period from 1945 to 2014 and who had at least 5 years of observed survival. None of these 22 patients were lost to follow-up, and they represent the long-term survivors (38%) from a total of 58 pediatric PFE patients treated. Nine (26%) of the 34 children treated during the pre-MRI era (1945–1986) were long-term survivors, while the observed 5-year survival rate in the children treated during the MRI era (1987–2014) was 13 (54%) of 24 patients. The majority of patients (n = 16) received adjuvant radiotherapy, and 4 of these received proton-beam irradiation. Six children had either no adjuvant treatment (n = 3) or only chemotherapy as adjuvant treatment (n = 3). Fourteen patients were alive at the time of this report. According to MRI findings, all of these patients were tumor free except 1 patient (age 78 years) with a known residual tumor after 65 years of event-free survival.Repeat resections for residual or recurrent tumor were performed in 9 patients, mostly for local residual disease with progressive clinical symptoms; 4 patients underwent only 1 repeated resection, whereas 5 patients each had 3 or more resections within 15 years after their initial surgery. At further follow-up, 5 of the patients who underwent a second surgery were found to be dead from the disease with or without undergoing additional resections, which were performed from 6 to 13 years after the second procedure. The other 4 patients, however, were tumor free on the latest follow-up MRI, performed from 6 to 27 years after the last resection. Hence, repeated surgery appears to increase the chance of tumor control in some patients, along with modern (proton-beam) radiotherapy. Six of 8 patients with more than 20 years of survival are in a good clinical condition, 5 of them in full-time work and 1 in part-time work.CONCLUSIONSPediatric PFE occurs mostly in young children, and there is marked risk for local recurrence among 5-year survivors even after gross-total resection and postoperative radiotherapy. Repeated resections are therefore an important part of treatment and may lead to persistent tumor control. Even though the majority of children with PFE die from their tumor disease, some patients survive for more than 50 years with excellent functional outcome and working capacity.

Long-term outcomes and prognostic factors in pediatric patients with severe traumatic brain injury and elevated intracranial pressure

2008 ◽  
Vol 2 (4) ◽  
pp. 240-249 ◽  
Author(s):  
Jay Jagannathan ◽  
David O. Okonkwo ◽  
Hian Kwang Yeoh ◽  
Aaron S. Dumont ◽  
Dwight Saulle ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Pediatric Patients ◽  
Elevated Intracranial Pressure ◽  
The Mean

Object The management strategies and outcomes in pediatric patients with elevated intracranial pressure (ICP) following severe traumatic brain injury (TBI) are examined in this study. Methods This study was a retrospective review of a prospectively acquired pediatric trauma database. More than 750 pediatric patients with brain injury were seen over a 10-year period. Records were retrospectively reviewed to determine interventions for correcting ICP, and surviving patients were contacted prospectively to determine functional status and quality of life. Only patients with 2 years of follow-up were included in the study. Results Ninety-six pediatric patients (age range 3–18 years) were identified with a Glasgow Coma Scale score < 8 and elevated ICP > 20 mm Hg on presentation. The mean injury severity score was 65 (range 30–100). All patients were treated using a standardized head injury protocol. The mean time course until peak ICP was 69 hours postinjury (range 2–196 hours). Intracranial pressure control was achieved in 82 patients (85%). Methods employed to achieve ICP control included maximal medical therapy (sedation, hyperosmolar therapy, and paralysis) in 34 patients (35%), ventriculostomy in 23 patients (24%), and surgery in 39 patients (41%). Fourteen patients (15%) had refractory ICP despite all interventions, and all of these patients died. Seventy-two patients (75%) were discharged from the hospital, whereas 24 (25%) died during hospitalization. Univariate and multivariate analysis revealed that the presence of vascular injury, refractory ICP, and cisternal effacement at presentation had the highest correlation with subsequent death (p < 0.05). Mean follow-up was 53 months (range 11–126 months). Three patients died during the follow-up period (2 due to infections and 1 committed suicide). The mean 2-year Glasgow Outcome Scale score was 4 (median 4, range 1–5). The mean patient competency rating at follow-up was 4.13 out of 5 (median 4.5, range 1–4.8). Univariate analysis revealed that the extent of intracranial and systemic injuries had the highest correlation with long-term quality of life (p < 0.05). Conclusions Controlling elevated ICP is an important factor in patient survival following severe pediatric TBI. The modality used for ICP control appears to be less important. Long-term follow-up is essential to determine neurocognitive sequelae associated with TBI.

scholarly journals Maternity Leave Duration and Full-time/Part-time Work Status Are Associated with US Mothers’ Ability to Meet Breastfeeding Intentions

2014 ◽  
Vol 30 (4) ◽  
pp. 416-419 ◽  
Author(s):  
Kelsey R. Mirkovic ◽  
Cria G. Perrine ◽  
Kelley S. Scanlon ◽  
Laurence M. Grummer-Strawn
Keyword(s):  
Maternity Leave ◽  
Work Status ◽  
Full Time ◽  
Time Work ◽  
Part Time ◽  
Time Part ◽  
Part Time Work

MULTIPLE SIMULTANEOUS APPROACH IN LOWER EXTREMITY SPASTICITY SURGERY

2000 ◽  
Vol 04 (03) ◽  
pp. 221-229
Author(s):  
Ugur Sayli ◽  
Sinan Avci
Keyword(s):  
Lower Extremity ◽  
Orthopedic Surgery ◽  
Daily Living ◽  
Operation Time ◽  
Postoperative Rehabilitation ◽  
Horse Riding ◽  
Simultaneous Surgery ◽  
The Mean ◽  
Different Levels

Lower extremity spasticity in CP interferes with daily living activities, such as ambulation and sitting as well as hygiene. Orthopedic surgery may be needed in the prevention and correction of the deformities and malalignments. Seven girls and nine boys with ages ranging from 7 to 17 years who had at least four surgeries at different levels of their lower extremities in a single stage were presented. Minimum follow-up was two years. The mean number of surgeries performed simultaneously was 6 (4 to 11). The mean operation time was 115 minutes (35 to 225 minutes) and the mean blood loss was 200 ml (100 to 600 ml) during surgery. The hospital stay ranged from two to six days. No complication which may be related to multiple simultaneous surgery was observed. Rehabilitation was begun as soon as the pain permitted. In the postoperative period, the diplegics attended sessions of hippotherapy — therapy by horse riding — in addition to formal therapy modalities. At the latest follow-up postoperatively, all the patients had increase in their level of activities. As a conclusion, whenever needed, simultaneous correction of the lower extremity deformities in spastic CP patients decreases costs and simplifies postoperative rehabilitation without increasing surgical risk for the patients.

scholarly journals A demographic profile of cervical injury: an Indonesian single tertiary hospital study with 6 months to 1-year follow-up

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Lukas Widhiyanto ◽  
Aliefio Japamadisaw ◽  
Kukuh Dwiputra Hernugrahanto
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Traffic Accidents ◽  
Tertiary Hospital ◽  
First Year ◽  
Cervical Injury ◽  
Significant Difference ◽  
Cord Injury ◽  
The Mean

Abstract Background Spinal cord injury (SCI) can cause considerable morbidity and mortality. Until now there is no spinal cord injury profile in Indonesia. Therefore, this study aims to provide an overview of the spinal cord injury profile as well as to analyze the functional outcome at the sixth month and the first year. Results Most spinal cord injury cases were traumatic SCI (67.5%). Meanwhile, non-traumatic SCI was 32.5%. The mean age of patients who had traumatic SCI was 41.9 ± 17.4 years while non-traumatic SCI patients was 48.4 ± 13.7 with a significant difference (p < 0.05). Most cases occurred in men rather than women with significant differences based on the type of injury (p < 0.05). Traffic accidents were the most common cause of cervical injuries (47.1%). Surgery was the most common treatment modality in cervical injury cases (60.4%) with the posterior approach being the preferred approach in most operative measures (72.4%). Respiratory failure was the leading cause of death (48.9%). The mean LOS of patients with traumatic SCI was 28.8 ± 14.3 days while the mean LOS of non-traumatic SCI patients was 44.7 ± 28.7 with a significant difference (p < 0.05). There was significance difference between the initial outcome and after the sixth month to first year follow-up (p < 0.05). Conclusions This study demonstrated the epidemiology and characteristics of spinal cord injury which mostly had a good neurological outcome.

scholarly journals Factors Associated With Use of Telemedicine for Follow-Up of SLE in the COVID-19 Outbreak

2021 ◽  
Vol 8 ◽  
Author(s):  
Ho So ◽  
Evelyn Chow ◽  
Isaac T. Cheng ◽  
Sze-Lok Lau ◽  
Tena K. Li ◽  
...  
Keyword(s):  
Care Delivery ◽  
Significant Proportion ◽  
Damage Index ◽  
Physician Global Assessment ◽  
Full Time ◽  
Systemic Lupus ◽  
Cross Sectional ◽  
Factors Associated ◽  
The Mean

Objective: To investigate the factors associated with telemedicine (TM) use for follow-up of Systemic Lupus Erythematous (SLE) patients in the COVID-19 pandemic.Methods: This was a single-centered cross-sectional study conducted in Hong Kong. Consecutive patients followed up at the lupus nephritis clinic were contacted for their preference in changing the coming consultation to TM in the form of videoconferencing. The demographic, socioeconomic, and disease data of the first 140 patients opted for TM and 140 control patients preferred to continue standard in-person follow-up were compared.Results: The mean age of all the participants was 45.6 ± 11.8 years, and the disease duration was 15.0 ± 9.2 years. The majority of them were on prednisolone (90.0%) and immunosuppressants (67.1%). The mean SLEDAI-2k was 3.4 ± 2.4, physician global assessment (PGA) was 0.46 ± 0.62 and Systemic Lupus International Collaborating Clinics (SLICC) damage index was 0.97 ± 1.23. A significant proportion of the patients (72.1%) had 1 or more comorbidities. It was found that patients with higher mean PGA (TM: 0.54 ± 0.63 vs. control: 0.38 ± 0.59, p = 0.025) and family monthly income &gt; USD 3,800 (TM: 36.4% vs. control: 23.6%; p = 0.028) preferred TM, while full-time employees (TM: 40.0% vs. control: 50.7%; p = 0.041) preferred in-person follow-up. These predictors remained significant in the multivariate analysis after adjusting for age and gender. No other clinical factors were found to be associated with the preference of TM follow-up.Conclusion: When choosing the mode of care delivery between TM and physical clinic visit for patients with SLE, the physician-assessed disease activity and patient's socio-economic status appeared to be important.

scholarly journals S100B Serum Level as a Mortality Predictor for Traumatic Brain Injury: A Meta-Analysis

2018 ◽  
Vol 6 (11) ◽  
pp. 2239-2244 ◽  
Author(s):  
Nyoman Golden ◽  
Tjokorda Gde Bagus Mahadewa ◽  
Citra Aryanti ◽  
I Putu Eka Widyadharma
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Head Injuries ◽  
Case Series ◽  
Mortality Data ◽  
Serum S100b ◽  
Significant Difference ◽  
The Mean

  BACKGROUND: The pathogenesis of inflammatory neuronal cell damage will continue after traumatic brain injury in which contributed to subsequent mortality. Serum S100B levels were shown to be an early predictor of mortality due to traumatic brain injury. AIM: This Meta-Analysis will analyse the mean and diagnostic strength of serum S100B levels between survived and died subjects with head injuries based on the various follow-up times of nine studies. METHODS: We conducted a meta-anelysis in accordance with PRISMA guidelines and adhering to Cochrane Handbook for Systematic Review of Interventions. Literature search was conducted on March 16, 2018 from Medline and Scopus in the past 10 years, using various keywords related to S100, brain injury, and outcome. Duplicate journals were sorted out via EndNote. Included articles were as follows: original data from the group, clinical trials, case series, patients undergoing serum S100B levels with both short- and long-term follow-up mortality. Data were collected for mortality, serum S100B levels, and its diagnostic strength. All data were analyzed using Review Manager 5.3 (Cochrane, Denmark). RESULTS: The results of the meta-analysis showed a significant difference in S100B levels between survived and died subjects with head injuries on overall follow-up timeline (0.91, 95.9% CI 0.7-1.12, I2 = 98%, p < 0.001), during treatment (1.43, 95% CI 0.97 to 1.89, I2 = 98%, p < 0.001), or 6 months (0.19; 95%CI 0.1-0.29, I2 = 76%, p < 0.001) with an average threshold value that varies according to the study method used. The mean diagnostic strength was also promising to predict early mortality (sensitivity of 77.18% and 92.33%, specificity of 78.35% and 50.6%, respectively). CONCLUSION: S100B serum levels in the future will be potential biomarkers, and it is expected that there will be standardised guidelines for their application.

scholarly journals Cross-Hand Replantation

2020 ◽  
Vol 53 (01) ◽  
pp. 124-130
Author(s):  
S. Raja Sabapathy ◽  
Hari Venkatramani ◽  
Sanjai Ramkumar ◽  
Monusha Mohan ◽  
Dafang Zhang
Keyword(s):  
Daily Living ◽  
Functional Results ◽  
Upper Extremities ◽  
Full Time ◽  
Gainful Employment ◽  
Wrist Flexor ◽  
Major Injury ◽  
Finger Motion ◽  
Hand Replantation

AbstractCombined major injury to both upper extremities, in which one hand is amputated and structurally intact but not replantable, and the other hand is unsalvageable, is a rare setting in which cross-hand replantation may be considered. We report a case of an emergency cross-hand replantation performed at the wrist level. In our case, insertions of the wrist flexor and extensor tendons at the second and third metacarpal bases were retained at the recipient, allowing for early active wrist motion and finger motion by tenodesis. Fascicle-specific nerve coaptations were performed. The patient achieved satisfactory functional results, allowing him independence with daily living activities and return to gainful employment. At the time of telemedicine follow-up at 5 years, he was employed full-time, reported no difficulty or mild difficulty with most daily activities, and preferred the use of his replanted hand over a contralateral prosthesis.

Long-term Stack splint immobilization for closed tendinous Mallet Finger

2020 ◽  
Vol 52 (03) ◽  
pp. 170-175
Author(s):  
In Tae Hong ◽  
Eugene Baek ◽  
Cheungsoo Ha ◽  
Soo-Hong Han
Keyword(s):  
Treatment Protocol ◽  
Interphalangeal Joint ◽  
Flexion Angle ◽  
Full Time ◽  
Mallet Finger ◽  
Distal Interphalangeal Joint ◽  
Distal Interphalangeal ◽  
The Mean ◽  
Crawford Classification

Abstract Background Closed tendinous mallet finger can be treated non-operatively by extension splinting of the distal interphalangeal joint (DIPJ) for 6 to 8 weeks. However, method of conservative treatment in detail differs among various reports, especially in type of orthosis, duration of full-time immobilization and additional night orthotic wear after full-time immobilization. In our institution, full-time Stack splint is applied with distal interphalangeal joint (DIPJ) in extension for 12 weeks and night orthosis is worn for 4 weeks. Purpose The purpose of this study was to evaluate clinical and functional outcomes of tendinous mallet finger using our treatment protocol. Patients and Methods Between March 2007 and December 2017, patients with tendinous mallet finger who were managed conservatively according to our treatment protocol were retrospectively reviewed. A total of 100 patients (101 cases) were enrolled, including 77 males and 23 females. Extension lag was measured before, soon after treatment, and at the final follow-up. Flexion angle of DIP joint was measured at the final follow-up. Patients were clinically evaluated based on the Crawford classification scale and Abouna & Brown criteria. Results The mean age of patients was 40 years and the mean follow-up was 48 months. The mean extension lag was 28.3 degrees initially and 2.6 degrees at the final follow-up. (p-value < 0.001) Flexion angle at the final follow-up was 68.3 degrees. Based on the Crawford classification scale, 56 % of patients had excellent results, and 25 % of patients had good results. According to Abouna & Brown criteria, 78 % of patients had success results and 7.5 % of patients had improved results. Conclusions Wearing orthosis for up to 16 weeks (12 weeks full time and 4 weeks night orthosis) in the treatment of tendinous mallet finger injuries can achieve satisfying result.

scholarly journals Evaluation of Rib Fractures due to Trauma

2021 ◽  
pp. 46-50
Author(s):  
Suphi Aydin ◽  
Ahmet Dumanli ◽  
Adem Gencer
Keyword(s):  
Gastrointestinal Bleeding ◽  
Hospital Stay ◽  
Traffic Accidents ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Rib Fractures ◽  
The Mean ◽  
One Year ◽  
The One

Introduction and Aim: We aimed to evaluate the one-year mortality rates and the effect of comorbid diseases on mortality in patients with trauma and isolated rib fractures. Materials and Methods: Ninety patients who had trauma, isolated rib fracture between January 2016 and December 2016 and could be reached after one year after the trauma were included in the study. The files of the patients were scanned retrospectively. Age, gender, and length of hospital stay were recorded. After one-year follow-up, they were contacted by phone to evaluate the rates of additional disease and mortality. Results: 27 of the patients were female (30%), 63 of them were male (70%). Regarding the causes of injury, there were falls in 42 patients at most and in-vehicle traffic accidents in 35 patients. The mean age was 56.85 ± 16.33, the mean hospital stay was 4.04 ± 4.55 days. The most common comorbidities were diabetes mellitus in 13 patients and hypertension in 11 patients. The least detected additional diseases are; Ulcerative colitis, epilepsy, arrhythmia, gastroesophageal reflux, gastrointestinal bleeding, rheumatism, Alzheimer and Familial Mediterranean Fever in 1 patient each. One patient died who had gastrointestinal bleeding. Mortality rate was 1.11%. Conclusions: Post-traumatic rib fractures disrupt people's quality of life and cause morbidity and mortality. Although the risk of comorbid mortality increases, close follow-up is important in preventing or reducing mortality rates.

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