Exploration of patient- and relative-reported outcomes of cognitive, emotional, and social function after encephalitis.

Objective: We evaluated cognitive, emotional, and social function after encephalitis, as perceived and reported by individuals post-encephalitis and their relatives.Hypothesis: There will be differential effects on various domains as self-reported by individuals post-encephalitis. Outcomes will be worse than in prior studies of other forms of acute brain injury. Post-encephalitis relative-report will demonstrate worse outcomes than self-report.Methods and Procedures: Members of The Encephalitis Society residing in the United Kingdom and Ireland were recruited to complete a demographic questionnaire and the European Brain Injury Questionnaire (EBIQ).Results: 266 individuals affected by encephalitis and 140 relatives participated in this study. The three domains with the highest (worst) mean scores were somatic, cognitive, and communication (p < .001). Individuals post-encephalitis self-reported worse outcomes than individuals post-stroke in seven of nine domains (p < .005), but there were no differences compared to individuals post-traumatic brain injury (TBI). Relatives reported worse encephalitis outcomes in seven of nine domains than did individuals directly affected by encephalitis (p < .005).Conclusions: Individuals affected by encephalitis experience the most significant symptoms in the somatic, cognitive, and communication domains. Outcomes as assessed by relatives were notably worse than those assessed by individuals themselves in nearly all domains.

Assessment of long-term psychosocial outcomes in anti-NMDA receptor encephalitis.

PURPOSE: The purpose of this study was to assess long-term psychosocial outcomes of anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (anti-NMDARE). METHODS: Adolescents and adults with self-reported anti-NMDARE were invited to complete an online survey distributed by relevant patient organizations. Demographic and clinical information was collected, including the diagnoses initially given for anti-NMDARE symptoms and posthospital care received. Patient-Reported Outcomes Measurement Information System (PROMIS) Psychosocial Impact Illness - Negative short form (Negative PSII) was administered to assess psychosocial outcome of anti-NMDARE. Associations between clinical factors and psychosocial outcomes were evaluated. RESULTS: Sixty-one individuals with anti-NMDARE age 15 years and above participated. Mean age was 33.7 years (standard deviation [SD]: 12.8), and participants were predominantly female (90.2%, n = 55). Mean T-score on PROMIS Negative PSII was 60.7, >1 SD higher (worse psychosocial function) than that of the provided normalized sample enriched for chronic illness (50, SD: 10). Initial misdiagnosis of anti-NMDARE symptoms was associated with decreased odds (odds ratio [OR]: 0.11, p < 0.05), and follow-up with a psychiatrist after hospitalization with increased odds (OR: 8.46, p < 0.05), of return to work/school after illness. Younger age of symptom onset and presence of ongoing neuropsychiatric issues were predictive of worse Negative PSII scores (p < 0.05). CONCLUSION: Individuals with anti-NMDARE demonstrate poor psychosocial outcomes, yet there are no current standards for long-term assessment or management of such symptoms in this population. These findings highlight the need for use of more comprehensive outcome measures that include assessment of psychosocial function and the importance of developing interventions that address this domain for individuals with anti-NMDARE.

Assessment of care transitions and caregiver burden in anti-NMDA receptor encephalitis.

PURPOSE: The purpose of the study was to assess care transitions and caregiver burden among caregivers of individuals with anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (anti-NMDARE). METHODS: Caregivers of individuals with anti-NMDARE were recruited via patient organization websites. Demographic and clinical information as well as responses to the Care Transition Measure 15 (CTM-15) and Zarit Burden Interview (ZBI) were collected. Exploratory factor analysis (EFA) was conducted on the ZBI, and underlying constructs were analyzed for associations with the CTM-15 and clinical characteristics. RESULTS: Seventy-six caregivers participated. On the CTM-15, the top items where caregivers disagreed or strongly disagreed were the following: "when the patient left the hospital, I had a readable and easily understood written plan that described how all of their healthcare needs were going to be met" (73%), "when the patient left the hospital, I was confident that I know how to manage their health" (62%), and "when the patient left the hospital, I had all the information I needed to be able to take care of them" (58%). Worse care transitions significantly predicted higher caregiver burden scores. Mean ZBI score was 44, falling in the moderate to severe burden range. Exploratory factor analysis was conducted and found four common underlying factors associated with total score. Factor 1, the impact of caring on caregivers' personal lives (accounting for 51% of total score variance), was selected for further analysis because of its modifiable nature. Higher ZBI scores were associated with lower CTM-15 scores (p < 0.003) and the individual with anti-NMDARE not returning to driving (p < 0.002). CONCLUSION: This study identified specific elements of care transitions and caregiver burden that are not currently being addressed for individuals with anti-NMDARE. Attention to these aspects of care in the development of targeted interventions may improve outcomes in individuals with anti-NMDARE and their caregivers.

Suprahepatic gallbladder with hypoplasia of the right lobe of the liver.

One of the rarest congenital anomalies of the gallbladder is the suprahepatic variant of this organ. Three cases of this ectopia were seen in a ten-year period, all of which associated with hypoplasia of the right lobe of the liver and upward displacement of the hepatic flexure of the colon, which overlapped the liver border. All patients complained of recurrent pain in the right upper quadrant of the abdomen, suggestive of biliary disease, but only one case had calculi in the gallbladder that was acute cholecystitis. Two patients underwent cholecystectomy, and operative findings confirmed the preoperative diagnosis. It is speculated that the primary defect in this modality of suprahepatic gallbladder might be hypoplasia or atrophy of the right lobe of the liver of a congenital nature, with subsequent vicious orientation of the gallbladder and upward displacement of the colon.

New technique of pancreaticojejunal anastomosis after partial pancreaticoduodenectomy.

The authors propose a new technique of pancreaticojejunal anastomosis after pancreatoduodenectomy with the aim of reducing the incidence of anastomotic disruption and late stenosis of the duct. Basically the technique consists of end-to-end pancreaticojejunal anastomosis with invagination of the pancreas into the intestinal loop and mucosal juxtaposition of the pancreatic duct and jejunum.

Anthropometric assessment of nutritional depletion after surgery injury.

Triceps skinfold (TS), arm muscle circumference (AMC) and body weight (BW) were studied prospectively in 20 adults, admitted to elective operations on the digestive tract, in order to evaluate these anthropometric parameters in planned surgical procedures performed in non-critically ill, non-stressed patients. Mean duration of the preoperative period was 19.2 days (range 1--38), and of the postoperative period, 14.1 days (range 6--31). Mean changes for BW were, respectively, -0.2% and -2.5%, AMC decreased -0.5% before operation and -3.4% afterwards, and TS was reduced to -1.9% in the preoperative phase, and to -8.4% postoperatively. These results are consistent with minimal anthropometric changes during the presurgical stay, with more striking decreases after operative injury. Postoperative findings were further examined in relationship to degree of surgical trauma and length of postoperative hospitalization. After the arbitrary selection of a 10% reduction as the limit for significant decrease in any of the analysed parameters, the percentage of impaired measurements was determined in the sub-groups of medium and large operations, two consecutive procedures, as well as postoperative stay of 6 to 14 days, 15 to 21 days, and over 3 wks. Decreased parameters comprised 6.0% (2/33) of the observations after moderate surgical manipulation, 27.7% (5/18) after serious trauma, and 66.6% (6/9) after two operations. Simarilarly they represented 2.7% (1/36) of the findings in patients discharged within 2 weeks, 33.3% (4/12) in those staying between 2--3 weeks, and 66.6% (8/12) in the cases remaining for longer periods. Despite the limited sensitivity of anthropometric parameters in the detection of acute moderate changes in body constitution, they were useful in separating the patients undergoing medium surgical injury from those subjected to more severe metabolic stress, when only changes greater than 10% of initial value were considered.

Endoscopic treatment of benign postanastomotic annular stricture of the cervical esophagus.

Although most patients presenting with a fibrotic stricture at an esophagocolic or esophagogastric anastomosis respond well to the classical dilation therapy, a number of them do not and are therefore considered to have a condition refractory to the classical method. In these cases, we performed fiberesophagoscopic section and segmentation of the stenosing ring itself, which did not exceed one cm in length, using appropriate equipment such as an electric endoscopic scalpel. Widening of the strictured segment was completed with successive dilations using a Maloney type bougie. Dysphagia disappeared after the endoscopic procedure in 21 (84%) of the 25 patients with stricture of the cervical anastomosis, after esophagocoloplasty or esophagogastroplasty, without any serious complications.

Esophagogastric anastomosis with valvuloplasty: an experimental study.

Twenty dogs divided into two equal groups were studied by the authors in order to evaluate the functional activity and the occurrence of reflux and esophagitis after esophagogastrectomy followed by a simple esophagogastric anastomosis (group A) and associated with an anti-reflux valve mechanism (group B). The functional activity was studied by manometry at the esophagogastric junction and the occurrence of esophagitis by histologic examination of the esophagus after 25 days of histamine gastric acid stimulation. In group A, no high pressure zone between the gastric and esophageal tracings were verified. Reflux and esophagitis which, occurred in all animals, was severe in 70%. In group B, manometry demonstrated that esophagogastropexy creates a high pressure zone. At deglutition this zone showed positive deflections, corresponding to the propagation of the peristaltic wave in the segment of esophagus, encircled by the stomach. Esophagitis, which was detected in 30%, was less severe than that observed in group A.

The origin and causes of struvite stones.

The aim of this paper is to evaluate the possible causes of the origin of "infection stones". The main differences between the ordinary biochemical parameters of a group of patients with this type of stones was analyzed and compared with a group of oxalocalcic stone-formers and with a group of healthy subjects. The importance of persistent basic urinary pH values is pointed out as possible origin of "infection stones" in some instances. The main urinary citrate concentration in patients with "infection stones" was significantly lower than in healthy subjects, this being an important factor that favours this kind of stone formation.

[Nodular lymphoid hyperplasia of the duodenum: study of 3 cases]. / Hiperplasia linfóide nodular do duodeno: estudo de 3 casos

We have studied three cases of patients with lymphoid nodular duodenal hyperplasia, two of them being in the child group. We observed giardiasis in one of the cases of this child group. Also vague dyspeptical complaints in all cases were noticed. The diagnostics were based on the results obtained with endoscopy, later confirmed by hystological tests. We found two cases with absence of IgA without alterations in IgG and IgM when using immunoeletrophoresis.