Hernia diafragmática traumática en niños: manifestación precoz y tardía / Traumatic diaphragmatic hernia: Precocious and delayed manifestations

Las lesiones traumáticas del diafragma son raras en niños e indican la presencia de un trauma severo con lesiones asociadas graves.EL diagnósticoo de la lesión siempre es difícil y en general es tardío.El objetivo de este estudio retrospectivo es presentar tres casos de hernia diafragmática traumática en niños,se analizó la evolución y se destaca la posibilidad de lesiones no identificadas con manifestaciones tardías.Dos pacientes fueron víctimas de atropellamiento con trauma abdominal cerrrado.EL otro fue víctima de herida penetrante en flanco izquierdo que fue saturado de urgencia y cinco años después presentó un cuadro de abdomen agudo que llevó al diagnóstico.Los pacientes fueron sometidos a laparotomía,con sutura primaria de diafragma y tratamiento de las lesiones asociadas.Las rupturas diafragmáticas traumaticas son raras,principalmente en niños y son de difícil diagnóstico.Las lesiones de diafragma deben ser sospechadas en politraumatismo y tambien en heridas penetrantes de la transición tóracoabdominal.La severidad del cuadro depende de las lesiones asociadas que muchas veces dificultan el diagnsotico inicial de la lesión retrasando el tratamiento precoz

Hernia diafragmática traumática en niños: manifestación precoz y tardía / Traumatic diaphragmatic hernia: Precocious and delayed manifestations

Las lesiones traumáticas del diafragma son raras en niños e indican la presencia de un trauma severo con lesiones asociadas graves.EL diagnósticoo de la lesión siempre es difícil y en general es tardío.El objetivo de este estudio retrospectivo es presentar tres casos de hernia diafragmática traumática en niños,se analizó la evolución y se destaca la posibilidad de lesiones no identificadas con manifestaciones tardías.Dos pacientes fueron víctimas de atropellamiento con trauma abdominal cerrrado.EL otro fue víctima de herida penetrante en flanco izquierdo que fue saturado de urgencia y cinco años después presentó un cuadro de abdomen agudo que llevó al diagnóstico.Los pacientes fueron sometidos a laparotomía,con sutura primaria de diafragma y tratamiento de las lesiones asociadas.Las rupturas diafragmáticas traumaticas son raras,principalmente en niños y son de difícil diagnóstico.Las lesiones de diafragma deben ser sospechadas en politraumatismo y tambien en heridas penetrantes de la transición tóracoabdominal.La severidad del cuadro depende de las lesiones asociadas que muchas veces dificultan el diagnsotico inicial de la lesión retrasando el tratamiento precoz

Depression accounts for executive function deficits in obsessive-compulsive disorder.

OBJECTIVE: To examine the relative impact of depression on executive function deficits in obsessive-compulsive disorder (OCD). BACKGROUND: Existing data suggest that OCD is associated with basal ganglia and orbital frontal dysfunction, and neurobehavioral abnormalities that are putatively associated with these regions have been demonstrated in OCD. Nonetheless, few studies have accounted for the effects of depression, which is a common concurrent symptom among those with OCD. METHOD: A broad battery of neuropsychological tests, including measures of executive function and sensory-motor function, was administered to 20 adults with OCD and 31 control subjects. To assess depressive severity, participants were administered the depression scale from the Minnesota Multiphasic Personality Inventory. RESULTS: Data were analyzed using a regression model in two steps. In step one, patient group was entered, and patients with OCD demonstrated a pattern of executive function and sensory-motor deficits, similar to those shown in previous research. In step two, self-reported depressive symptom severity was entered as a predictor. As a consequence, depression accounted for some executive function deficits, whereas presence of OCD only predicted performance on measures of sensory-motor function. CONCLUSIONS: These data suggest that abnormalities involving executive function in OCD are related to co-morbid depressive severity. However, sensory-motor deficits seem to be more consistent with basal ganglia/orbital frontal dysfunction in OCD.

Practice effects on the Wisconsin Card Sorting Test-64 Card version across 12 months.

The Wisconsin Card Sorting Test (WCST: Heaton, Chelune, Talley, Kay, & Curtiss, 1993) is among the most commonly administered measures of executive function. Recently, a short form of the test was developed (WCST-64: Kongs, Thompson, Iverson, & Heaton, 2000), and it affords psychometric properties commensurate with the full version of the test. Yet, similar to other measures of executive function, relatively little is known concerning the effects of repeated administration on the WCST-64. Towards this end, 53 men (age M = 32.38) were administered the WCST-64 twice over 12 months, and scores on several indices improved significantly during this interval. Suggestions concerning the use of these measures in longitudinal research designs and clinical follow-up examinations are offered, and reliable change indices concerning these measures are included.

Neurobiological relationships between ambient lighting and the startle response to acoustic stress in humans.

A study was conducted to determine differences between psychophysiological responses to acoustic stress under different ambient lighting conditions. Typical cool-white indoor lighting was compared to full-spectrum lighting under dim and bright illumination levels. Full-spectrum lighting exhibits spectral characteristics that approximate those found in natural sunlight. The startle response was measured during three preliminary experiments using normal subjects. In the first experiment, one subject was evaluated. Electromyography (EMG) was used to measure eyeblink startle at the obicularis oculi muscle; heart rate (HR) was measured at the wrist; and galvanic skin conductance (GSC) was measured at the left index finger. There was a significant increase in galvanic skin conductance (GSC) and a decrease in heart rate. In the second experiment, GSC was used to measure the startle response under cool-white fluorescent lighting versus full-spectrum fluorescent lighting (n = 5 subjects) under both bright and dim lighting conditions. Higher arousal was detected measuring GSC under the cool-white lighting condition, and under the dim lighting condition using both types of lighting. In the third experiment, ten subjects were assessed for GSC startle response using both lighting types set at the dim brightness level. There was a strong trend indicating a higher GSC arousal under the dim cool-white lighting condition. Other studies support that a GABAergic inhibitory circuit is inhibited by darkness and that the spectral characteristics of cool-white lighting are more stressful to humans than full-spectrum lighting. These preliminary findings regarding stress and ambient lighting may be especially important in the neural development of children, and in those clinical populations that are particularly sensitive to environmental stress.

Neurobehavioural consequences of substance abuse and HIV infection.

Although our understanding of how human immunodeficiency virus (HIV)-related neurobehavioural deficits develop is nascent and preliminary, some clues have emerged which may clarify lingering uncertainties. In particular, HIV seems to yield brain dysfunction by mediating pathological changes upon neuronal function. HIV also compromises immunological integrity, thereby resulting in secondary infections that may further increase brain dysfunction. Notably, many individuals with HIV tend to be current or past abusers of drugs, and, in some cases, their drug use may have actually presented a pathway for initial HIV infection. Similar to HIV, many drugs tend to yield pathological changes upon neuronal function. Further paralleling HIV, some drugs seem to compromise immune function, which in turn may yield secondary detrimental effects upon the brain. Yet, despite the relatively high comorbidity rates of HIV infection and substance abuse, few investigations have addressed the potential interaction between these two factors upon neurobehavioural status. Towards this end, the present paper reviews the existing literature concerning neuropsychological effects of HIV and substance use, and suggests potential mechanisms whereby substance use may potentiate and exacerbate the onset and severity of neurobehavioural abnormalities in HIV infection.

PPVT-R as an estimate of premorbid intelligence in older adults.

The Peabody Picture Vocabulary Test-Revised (PPVT-R) was examined as an estimate of premorbid intelligence in a clinical sample of elderly patients (N = 150) undergoing clinical neuropsychological evaluation. PPVT-R standard scores were compared across grossly cognitively intact, mildly/moderately and severely impaired groups of patients, and compared to a short form of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the Barona regression equation. Results indicate that, while the PPVT-R is vulnerable to increasing levels of cognitive impairment among patients with fewer years of education, the PPVT-R is stable across mild to moderate levels of impairment for patients with greater than 12 years of education. In a sub-sample of grossly cognitively intact patients (n = 91), the PPVT-R standard score correlated significantly with estimated WAIS-R FSIQ (r =.61). Compared to the Barona equation, the PPVT-R was less likely to over-estimate WAIS-R FSIQ in the grossly cognitively intact patients. These data suggest the PPVT-R to be a useful estimate of premorbid ability for patients with a greater than high-school education.

Sex differences on the WMS-III: findings concerning verbal paired associates and faces.

Previous research suggests that women have better verbal learning than men, whereas there is little evidence of sex differences in nonverbal learning. The present study examined whether sex differences occur on subtests from the Wechsler Memory Scale-III (Wechsler, 1997). Verbal Paired Associates I & II (VPA) and Faces I & II were administered to 26 male and 26 female undergraduates. A measure of visual-spatial perception, the Judgment of Line Orientation Test, (JLO) was also administered. This was done to place the study within the context of an established literature concerning sex differences in cognition. To rule out potential confounds due to intelligence, WAIS-R FSIQs were estimated and used as covariates in statistical analyses. Women outperformed men on several VPA indices, with men scoring at the 25th percentile and women scoring at the 50th percentile. Although no differences were observed on Faces I & II, men outperformed women on JLO. Implications and recommendations concerning the clinical use of VPA are discussed.

Estimated premorbid intelligence mediates neurobehavioral change in individuals infected with HIV across 12 months.

This study tested whether estimated premorbid intelligence moderates worsening neurobehavioral dysfunction in HIV infection. 155 homosexual men (54 controls, 49 HIV+ asymptomatic, 24 HIV+ symptomatic, 28 AIDS) with stable disease status were tested on measures of executive function at baseline and 12-month follow-up. Premorbid intelligence was estimated on the basis of a demographically-based regression equation (Hamsher, 1984), and participants were classified as average or above-average intelligence. Regardless of disease status, participants with above-average IQ showed no declines on measures of executive function across time. In contrast, among those with average IQ, symptomatic groups showed declines, whereas the asymptomatic group did not. The findings support the hypothesis that estimated premorbid intelligence mediates declines in neuropsychological function in patients with stable HIV status. These findings are consistent with theoretical models of cognitive reserve capacity.

Effects of immunosuppression and disease severity upon neuropsychological function in HIV infection.

Effects of immunosuppression and illness severity upon neuropsychological function were assessed in a group of homosexual men with AIDS across 6 months. Participants included 62 who were seronegative (HIV-), 74 asymptomatic seropositives (HIV+A), 31 symptomatic seropositives (HIV+S), 23 with AIDS defining illnesses (AIDS-DI), and 10 who were diagnosed with AIDS solely on the basis of CD4+ levels falling below 200 /mm3 (AIDS-CD4). Groups were equivalent in age, education, and IQ. None were drug users, and none experienced a change in disease status across the 6-month inter-test interval. There was little evidence of cognitive decline across time. Nonetheless, after collapsing across time intervals, the AIDS-DI group had worse new-learning than all other groups. Additionally, the AIDS-DI demonstrated a greater number of impaired performances than the other participant groups. The data suggest that cognitive impairment in AIDS is unlikely due to independent contributions of immunosuppression and illness. Rather neurobehavioral deficits are more likely attributable to a combination of the two.

Limited accuracy of premorbid intelligence estimators: a demonstration of regression to the mean.

Regression-based premorbid intelligence estimators have been devised by Barona, Reynolds, and Chastain (1984), Barona and Chastain (1986), Hamsher (1984), Krull, Scott, and Sherer (1995; the Oklahoma Premorbid Intelligence Estimate: OPIE), and Vanderploeg, Schinka, and Axelrod (1996; BEST-3 approach), but little is known of their relative accuracy, particularly in outer ranges of intellectual ability (e.g., below-average, superior, etc.). Towards this end, the Wechsler Adult Intelligence Scale-Revised (WAIS-R) was administered to 150 neurologically normal adults, and estimated VIQ, PIQ, and FSIQ scores were computed according to each regression method. Results showed that methods based solely on demographic factors were most susceptible to meanward regression, rendering them poor estimators of IQ scores in outer ranges. Although the OPIE and BEST-3 performed somewhat better, their accuracy remained relatively weak. The findings suggest that regression-based estimates of premorbid IQ are very susceptible to error, particularly in outer ranges of intellectual function.

Relative memory deficits in recurrent versus first-episode major depression on a word-list learning task.

Although memory deficits are associated with major depressive disorder, few studies have identified which patient characteristics predict impairment. Because recurrent depression appears related to more severe cerebral dysfunction, the present study tested whether recurrent depressed individuals have worse memory function than first-episode depressed individuals. Two groups of young-adult, nonpsychotic, depressed inpatients (20 single episode [SE] and 46 recurrent episode [RE]) were administered the California Verbal Learning Test within a broader battery of neuropsychological tests. The groups were equivalent in age, education, estimated IQ, severity of depression, and demographic composition. The RE group demonstrated memory deficits relative to both the SE group and published norms, but no other significant difference was found across the battery. Data indicate that abnormal memory performance is associated with recurrent depression, whereas memory deficits are not prominent in first-episode depressed individuals.

Effects of experimentally-induced emotional states on frontal lobe cognitive task performance.

A growing body of evidence suggests that dysphoric and euphoric emotional states are associated with reliable patterns of frontal lobe activity. Specifically, dysphoric affect coincides with greater right than left frontal lobe activity, and euphoric affect tends to correspond with a converse pattern of activity. The present study examined whether cognitive outcomes associated with the left and right frontal lobes are differentially influenced by dysphoric and euphoric affect. In a completely between-groups design, 60 dextral women were administered either the positive or negative conditions of the Velten Mood Induction Procedure, and they subsequently completed either a verbal or figural fluency test. Euphoria resulted in better verbal than figural fluency performance, and dysphoria yielded better figural than verbal fluency outcomes. These findings are consistent with electrophysiological data concerning frontal lobe activity during euphoric and dysphoric affect, and they underscore the notion that affective influences upon cognition are more complicated than previously thought.

Neuropsychological deficits in psychotic versus nonpsychotic unipolar depression.

A broad range of neuropsychological function was compared in samples of young adult unipolar depressed inpatients with and without psychotic features. Consistent with expectations, the psychotic depressive group demonstrated a broad range of deficit and had more impaired performances than the nonpsychotic group. Relevance of these data for hypotheses concerning psychotic depression as a unique diagnostic entity is discussed. In the context of previous research, the current findings suggest that accounting for individual differences in depression may clarify discrepancies between earlier studies of neuropsychological function in depression, and our understanding of the mechanisms by which depression influences cognition may be refined.

Practice effects on commonly used measures of executive function across twelve months.

Fifty men (age M = 32.50; education M = 14.98 years) were administered the Wisconsin Card Sorting Test (WCST), Ruff Figural Fluency Test (FFT), Verbal Concept Attainment Test (VCAT) Trail Making Test, Parts A and B (TMT), and F-A-S Verbal Fluency at baseline and 12 months later. WCST, FFT, and VCAT scores improved significantly over a 12-month interval. In contrast, TMT and F-A-S scores did not change. Level of intellectual ability failed to moderate the effect of previous testing upon performance. Suggestions concerning the use of these measures in longitudinal research designs and clinical follow-up examinations are offered, and reliable change indices concerning these measures are included.

Neuropsychological correlates of negative, disorganized and psychotic symptoms in schizophrenia.

Recent studies suggest that three dimensions (negative, disorganized and psychotic) categorize schizophrenic symptoms. A developing literature indicates distinct cerebral correlates of each symptom cluster, but few investigations have determined their neuropsychological correlates. In the present study, the Schedules of Negative and Positive Symptoms measured symptom severity in 62 schizophrenics, and a subsequent principal components analysis revealed three symptom dimensions. Factor scores, age and parental socio-economic status were simultaneously entered into regression equations to explain variance across a broad neuropsychological test battery. Negative symptoms were associated with deficits involving intelligence, executive function, memory, sustained-attention and sensory-motor function, whereas disorganized symptoms correlated with decreased intelligence, attention-span and sensory-motor function. Psychotic symptoms were unrelated to deficits. These data are consistent with hypotheses that these three symptom dimensions have distinct neurobehavioral correlates.

Cognitive deficits distinguish patients with adolescent- and adult-onset schizophrenia.

Recent studies have shown that patients with schizophrenia who have an adolescent-symptom onset (before age 21) have a worse clinical course and greater frequency of cerebral abnormalities than those with an adult-onset (after age 25). However, little is known about the neuropsychological functioning of these groups. A comprehensive neuropsychological examination was administered to groups of patients with schizophrenia with either an adolescent- or adult symptom-onset and a healthy control group. The adolescent-onset group performed worse than the adult-onset and control groups, particularly on measures of memory and executive function. The adult-onset group also performed worse than the controls, but to a lesser extent than did the adolescent-onset group. Results are discussed with reference to hypotheses that adolescent-onset schizophrenia represents a distinct neurodevelopmental disease entity.

Laparoscopia en el testiculo no palpable / Laparoscopy in impalpable testis

Alrededor del 20 por ciento de los pacientes con anomalias del descenso testicular, presentan uno o ambos testiculos no palpables. Se han utilizado diversos ex menes para localizar la gonada, con resultados poco satisfactorios. La laparoscopia es un metodo seguro y eficaz para la localizacion de los testiculos no palpables, permitiendo ademas la realizacion de procedimientos terapeuticos, como la ligadura de los vasos gonadales. La orquiectomia y la orquidopexia. Entre Mayo de 1987 y Abril de 1996, 28 niños con testiculo no palpable (4 de ellos bilaterales) y con edades entre 2 y 15 años, fueron sometidos a laparoscopia. De los 32 testiculos, 18 (56,2 por ciento) fueron localizados en el abdomen. En 8 casos se ligaron por esta via los vasos espermaticos, como primer tiempo de la tecnica de Fowler-Stephens, otros 10 testiculos fueron tratados con orquidopexia convencional. En 3 casos (9,4 por ciento) se diagnostic" agenesia testicular, 6 eran "vanished testis" (18,8 por ciento) y 5 (15,6 por ciento) (2 "vanished y 3 que fueron descendidos). La ecografia no fu confiable, presentando resultados positivos en menos del 20 por ciento. El examen laparocopico permitio diagnosticar la presencia de la gonada y realizar procedimientos terapeuticos. Ademas ayudo a planificar el tratamiento convencional, con poco indice de complicaciones, por lo que es un procedimiento de eleccion en la pesquisa de los testiculos no palpables

Extraccion de cuerpos extrajos del esofago con sonda de Foley / Removal of foreign bodies from esophagus with Foley catheter

La ingestion de cuerpos extrajos es un accidente frecuente en la poblacion pediatrica: aproximadamente el 90 de los objetivos son romos y los m s corrientes son las monedas. Con mayor frecuencia se alojan en el esofago cervical. En los ultimos 4 años utilizamos una sonda de Foley para la extraccion de cuerpos extraños del esofago proximal en 28 niños sin requerir endoscopia ni anestesia general. De los 28 niños con cuerpos extraños fue exitosa la extraccion en 26. En otros dos niños fue necesario realizar una esofagoscopia bajo anestesia general. La extraccion de cuerpos extraños del esofago con sonda de Foley es una opcion eficaz, segura y de bajo costo. No hubo complicaciones con esta tecnica

Laparoscopia en el testiculo no palpable / Laparoscopy in impalpable testis

Alrededor del 20 por ciento de los pacientes con anomalias del descenso testicular, presentan uno o ambos testiculos no palpables. Se han utilizado diversos ex menes para localizar la gonada, con resultados poco satisfactorios. La laparoscopia es un metodo seguro y eficaz para la localizacion de los testiculos no palpables, permitiendo ademas la realizacion de procedimientos terapeuticos, como la ligadura de los vasos gonadales. La orquiectomia y la orquidopexia. Entre Mayo de 1987 y Abril de 1996, 28 niños con testiculo no palpable (4 de ellos bilaterales) y con edades entre 2 y 15 años, fueron sometidos a laparoscopia. De los 32 testiculos, 18 (56,2 por ciento) fueron localizados en el abdomen. En 8 casos se ligaron por esta via los vasos espermaticos, como primer tiempo de la tecnica de Fowler-Stephens, otros 10 testiculos fueron tratados con orquidopexia convencional. En 3 casos (9,4 por ciento) se diagnostic" agenesia testicular, 6 eran "vanished testis" (18,8 por ciento) y 5 (15,6 por ciento) (2 "vanished y 3 que fueron descendidos). La ecografia no fu confiable, presentando resultados positivos en menos del 20 por ciento. El examen laparocopico permitio diagnosticar la presencia de la gonada y realizar procedimientos terapeuticos. Ademas ayudo a planificar el tratamiento convencional, con poco indice de complicaciones, por lo que es un procedimiento de eleccion en la pesquisa de los testiculos no palpables