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Biomedical subjects

L Sazbon

Publications and source records attributed to L Sazbon.

At least 19 recordsLinked to original sources
PubMed1994

Follow-up studies of somatosensory evoked potentials and auditory brainstem evoked potentials in patients with post-coma unawareness (PCU) of traumatic brain injury.

Some patients who suffer severe traumatic brain injury (TBI) fail to recover higher brain functions in spite of giving the appearance of sleep-wake cycles. Such a state is called post-coma unawareness (PCU) and varies in type and degree. Patients may remain in this state for months or even years. This study focused on the follow-up of upper-limb somatosensory evoked potential (USEP) measurements and auditory brainstem responses (ABR), with an emphasis on dynamic changes, in 10 patients with PCU resulting from TBI. The prognostic value of USEP and ABR was evaluated. Results showed that the presence of ABR in PCU patients had no prognostic value, because ABRs were found both in patients who recovered and those who did not, even a year after the trauma. The presence of normal ABR in PCU patients may suggest that the brainstem has been spared in the pathoanatomy of the PCU condition, with the significant damage occurring above this level, in cortical and subcortical (that is, hemispheral) areas. USEP was graded using the new system of Houlden [1] for 'acute' comatose patients. It was found that USEP measurements had some prognostic value in PCU patients. Most of the patients who remained in the PCU state had grade 2 or less initially, whereas most of the patients who later recovered or achieved at least a 'reduced life' state were grade 4 or more. On initial testing (when all patients were still in the PCU state), defined cortical potential (mainly in the slope of the building NI potential) was seen in only some of the patients who later recovered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Influence of muscle tone and force on ossification in postcomatose patients].

68 post-traumatic brain-injured patients in postcomatose unawareness (PCU) states were admitted during 1982-1987. 32 of them also suffered from fractures of the long bones and pelvis (total of 51 limbs). The muscle tone and force of all limbs were examined and x-rays of the large joints and of the fractures were taken periodically. Periarticular new-bone formation appeared in 32 patients. Normal callus developed in 41 fractured limbs and hypertrophic callus in 18. We found that pathological muscular tone (hypertonus and hypotonus) and pathologically decreased muscle force (paresis and plegia) were closely correlated with the appearance of periarticular new-bone formation. The extent of callus formation was not correlated with muscle tone and force.

Biomechanical Phenomena↗
PubMed1991

Medical complications and mortality of patients in the postcomatose unawareness (PC-U) state.

Almost half of all patients with traumatic brain injury who remain unconscious for more than one month will not recover consciousness and will remain in a state of prolonged postcomatose unawareness (PC-U). The aim of this work is to present the survival rate and medical complications of such patients. The survival time of the 62 patients studied ranged from 2 to 115 months, with a median of 15.5 +/- 22 months. Cumulative mortality figures were 15% at 3 months, 40% at 6 months and 60% and the end of the first year. The figures at the end of the second, third and fifth years were 86%, 87% and 94%, respectively. This type of data may aid in decisions regarding the management of these patients. The longer survival with better treatment of patients in a state of PC-U poses severe ethical, medical, legal and economic problems with which society will have to deal.

Adult↗
PubMed1991

Prognosis for recovery from prolonged posttraumatic unawareness: logistic analysis.

This study reviews the course and outcome of 130 patients who remained in a state of prolonged unawareness 30 days after severe cranio-cerebral trauma. Prognostic indicators and outcome were fitted by a logistic model. The significant prognostic factors observable in the first week after trauma were found to be ventilatory status, motor reactivity and significant extraneural trauma. The significant prognostic factors after the first month of unawareness were early ventilatory status, early motor reactivity, late epilepsy and hydrocephalus. The estimated probability of recovery of awareness (that is, consciousness) ranged from 0.94 in patients with early decorticate posturing in the absence of both extraneural trauma and ventilatory disturbance to 0.06 in patients with flaccidity, extraneural trauma and ventilatory disturbance in the first week after injury.

Arousal↗
PubMed1990

Outcome in 134 patients with prolonged posttraumatic unawareness. Part 1: Parameters determining late recovery of consciousness.

A retrospective study of 134 patients in a condition of prolonged unawareness state (that is, in coma for over 1 month) following brain trauma was conducted in order to identify prognostic factors. Eight easily evaluated parameters were found to be significant for predicting nonrecovery of consciousness. The following six features were present during the early posttraumatic phase (that is, during the 1st week after trauma): fever of central origin; diffuse body sweating; disturbances in antidiuretic hormone secretion; abnormal motor reactivity; respiratory disturbances; and diffuse nonneurological injuries. The first three features were manifestations of hypothalamic damage. Two factors, evident at a late phase following injury (after the 1st week posttrauma), namely late epilepsy and communicating hydrocephalus, were also significant in predicting nonrecovery.

Adolescent↗
PubMed1990

Outcome in 134 patients with prolonged posttraumatic unawareness. Part 2: Functional outcome of 72 patients recovering consciousness.

Most publications regarding the outcome of traumatic brain injury include patients with periods of unconsciousness of varying durations. The aim of the present paper is to describe the outcome of 72 patients who suffered from prolonged unawareness for more than 30 days and subsequently recovered consciousness. Almost half of the patients were independent in activities of daily living and another 20% were only partially dependent. Cognitive and behavioral deficits were the most common central nervous system sequelae of injury. Eight patients (11.1%) were able to resume working in the open job market and 35 (48.6%) were engaged in sheltered workshops. Most of the patients (72%), including all those who were working, were living with their families. Although the mean rehabilitation period was about 15 months, over 70% of these severely injured patients are considered to be socially integrated, enabling them to enjoy a reasonable quality of life.

Activities of Daily Living↗
PubMed1984

The diagnostic value of three common primitive reflexes.

Systematic attempts were made to elicit the snout, palmomental and corneomandibular reflexes in 50 young patients with prolonged traumatic coma, 50 elderly hemiplegics soon after their first cerebrovascular accident and in 100 normal age-matched controls. None was found significantly more frequently alone in brain-damaged patients than in age-matched controls. Only combinations of two or three reflexes showed diagnostic value in distinguishing between neurologically damaged patients and normal age-matched controls. Only the combination of all three was completely absent in the normal controls; this combination was found in 13% of the brain-damaged subjects.

Adult↗
PubMed1983

Hypothalamic-pituitary function in patients with prolonged coma.

In eight patients (six males and two females) hospitalized for prolonged coma (164-1320 days; five patients were in traumatic coma, two after cardiac arrest during surgery, and one after a venomous scorpion sting), diurnal variation of cortisol secretion, human (L) GH, PRL, TSH secretion as well as the release of the pituitary hormones after TRH and L-dopa stimulation were assessed. Serum T4 cortisol, hGH, hPRL, and hTSH levels were normal. The cortisol diurnal variation was preserved in six patients. In seven of eight patients, the hPRL and hTSH responses to TRH test were normal and in five patients, there was a rise of more than 150% in serum hGH concentrations. After L-dopa administration, five patients responded with a rise in hGH. In three patients, there was no response of hGH to TRH or L-dopa. Five patients responded with significant reduction in the serum hPRL concentration after L-dopa, and in three patients, no change was observed. It was concluded that patients with prolonged coma have variable hypothalamic pituitary function. They preserve the cortisol diurnal variation and the hypothalamic-pituitary-thyroid axis as well as PRL secretion; however, hGH secretion may respond abnormally to various stimuli.

Adult↗
PubMed1983

Growth hormone and periarticular new bone formation--a causal relationship? A preliminary communication.

In an attempt to examine the relationship between growth hormone (GH) and periarticular new bone formation (PNBF), we studied eight patients with brain lesions of different origins who were in a prolonged comatose state for 164 to 1320 days. Five of them developed PNBF. The latter reacted to both the specific L-Dopa test and to the non-specific TRH test with an increase in GH serum concentration. Those patients who did not develop PNBF, failed to react significantly to either tests. The difference in GH values between the two groups is statistically significant at the 95% level of confidence. We hypothesize that there may be a causal relationship between high concentrations of GH in serum and PNBF.

Adolescent↗
PubMed1981

Widespread periarticular new-bone formation in long-term comatose patients.

Widespread periarticular new-bone formation (myositis ossificans) was studied in 45 patients with brain damage who were in long-term coma. Thirty-six of these patients displayed myositis ossificans around at least one major joint. The development of myositis ossificans was shown to be independent of the sex and age of the patient and also of the aetiology, duration and outcome of the coma. Radiographic evidence first appeared between one and two months after the onset of coma. The maximal spread of myositis ossificans was reached in the first five months after the onset of coma. Progression of the disease was not observed after 14 months. Myositis ossificans was defined as a progressive self-limiting disease found in comatose patients.

Adolescent↗
PubMed1980

The value of electroencephalography in prolonged coma: a comparative EEG-computed axial tomography study of two patients one year after trauma.

Interest was aroused in two patients of 16 and 17 years of age and similar craniocerebral trauma, but who had differing EEG's 1 year after injury while their later situation was the reverse of what the EEG would have led one to expect. The patient with an iso-electric EEG showed clinical improvement during the course of the second year, as indicated by a rise in his Glasgow coma rating from 8 to 11. This patient had marked cortical atrophy with discrete central atrophy, shown by computed axial tomography (CT); the isotope cisternogram showed good peripheral absorption of the isotope and no penetration into the ventricles. The other patient showed diffuse slow-wave activity in his EEG but failed to improve clinically or electroencephalographically. His CT-scan showed marked central and discrete cortical atrophy; his isotopic cisternogram showed penetration of isotope into the ventricles with poor peripheral absorption. These two cases illustrate the hazard of relying on an iso-electric EEG after 1 year of coma as an indicator of brain death, and the value of the CT-scan in the initial assessment of such cases.

Adolescent↗
PubMed1978

Gastrointestinal hemorrhage in long-lasting traumatic coma.

Sixteen cases, aged 19 to 61 years and suffering from traumatic coma were studied for periods varying from 7 to 20 months. Obvious or occult gastrointestinal hemorrhage appeared in every case, the earliest presentation being after a few weeks and the latest at 20 months. Gastric acidity was normal in 15 cases. Five patients had duodenal ulceration in repeated roentgenological examination. Concomitant clinical findings included clubbing and paraarticular new bone formation in 9 patients. In addition, hypoxia with repeated values between 63 and 88 mm was observed in 13 of the 16 patients. The latter observation strongly suggests that hypoxia of gastrointestinal mucosa may, indeed, play a pathogenetic role in gastrointestinal hemorrhage of patients with C.C.I.

Adult↗
PubMed1978

Recovery of communicative functions after prolonged traumatic coma.

Fifteen patients with prolonged coma after craniocerebral injury were observed for a year or more, and their communicative functions were evaluated. Nine of them showed a considerable degree of recovery, while 6 remained in a vegative state. Of the 9 with recovery, 6 showed complete recovery of semantic functions, while 3 remained with aphasic deficits. Eight out of these 9 remained dysarthric. Communicative recovery began as late as 5.7 months after injury, and it roughly paralleled recovery in locomotion and A.D.L. Restlessness and sweating were favorable prognostic factors. Excessive salivation, snout reflex, corneomandibular reflex, retractory nystagmus and stereotypic movements were unfavorable. The 8 patients who remained dysarthric showed marked diminution of their expiratory and inspiratory reserves, and of their forced vital capacity.

Adult↗
PubMedDate not supplied

Severe behavioural disturbance in families of patients with prolonged coma.

This paper describes the psychological dynamics among family members of patients with prolonged coma. We discuss the conflicts these families meet and how they affect their interpersonal relationships. Special focus is placed on overt and covert aggression towards the attending staff, an issue that has not received much attention. The unconscious motives underlying these overt aggressive behaviours are described, with an emphasis on how projective mechanisms come into play. We suggest a partial solution to be implemented in units treating these kinds of patients.

Adult↗
PubMedDate not supplied

Heterotopic bone formation involving wrist and fingers in brain-injured patients: a report of three cases.

Periarticular new bone formation is frequently observed in patients with prolonged coma, usually affecting large joints such as shoulders, elbows and hip joints. Unusual locations of PNBF involving the wrist and the inter-phalangeal joints are described in three patients who were in coma due to anoxic or traumatic brain insults. In each case flexor ankylosing positions were the end result.

Adult↗