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Biomedical subjects

Z Groswasser

Publications and source records attributed to Z Groswasser.

68 records · Page 4Linked to original sources
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Dreams in head-injured patients.

It is commonly believed that patients following severe head injury tend to dream less than before the injury. In order to evaluate this assumption 51 married head injury patients were interviewed about the frequency and content of their dreams before and after injury. Dreams with threatening content and dreams with manifest sexual content were especially analysed. The results indicate that the overall incidence of dreams in the late post-traumatic phase was similar to the pre-injury era. Threatening dreams were almost significantly more frequent after injury, and the reported incidence of dream with sexual manifest content decreased significantly post-injury. It is suggested that the dynamic mechanism for this phenomenon in head-injured patients is different from that found in the post-traumatic neurosis syndrome.

Adaptation, Psychological↗
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Practice of prophylactic anticonvulsant treatment in head injury.

The policy of patient selection for prophylactic anticonvulsant treatment has been evaluated retrospectively in 124 head-injured patients admitted consecutively for rehabilitation after primary neurosurgical treatment. Prophylaxis had been instituted in about 60% (51/83) of high risk patients and in about 30% (12/41) of the patients who did not belong to the high risk categories. The use of existing risk data as guidelines for decisions about anticonvulsant prophylaxis is discussed.

Adolescent↗
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Convergence insufficiency in brain-injured patients.

Disorders of eye movements are relatively common in brain-injured patients. Some of these disturbances are caused by direct trauma to the orbital content, cranial nerves and other brain areas. Convergence, which is a part of the near-vision complex and depends on the integrative function of the cortical and subcortical areas, is commonly affected by traumatic brain injury. Intact vergence needs the integrative function of brain structures associated with acquisition of information on one side and intact mesencephalic function, including function of a vergence integrator, and their interconnections. Clinical investigation of vergence function in 26 traumatically brain-injured patients examined as early as possible after trauma revealed disturbances in over a third of the examinees. A follow-up of 72 patients some 3 years after injury revealed vergence insufficiency in 42%. Convergence insufficiency was associated with longer periods of coma (p less than 0.001), presence of cognitive disturbances (p less than 0.005) and patients' failing to find work in the open market (p less than 0.01). It is suggested that the presence of disturbed vergence several years after trauma, and its close association with prolonged coma and cognitive disturbances, is an expression of permanent damage to mesencephalic and cortical brain structures and can serve as an important aid in evaluation of these patients. This paper describes the close relationship between vergence state and over-all rehabilitation outcome as evaluated by patients' occupational status.

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↗
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Polytrauma associated with traumatic brain injury: incidence, nature and impact on rehabilitation outcome.

The rehabilitation outcome of patients with severe traumatic brain injury (TBI) is well documented and is highly correlated to the neurobehavioural sequelae of CNS damage. However, many of these patients suffer from polytrauma involving systems other than the CNS and to systems involved in acquisition of external information. In the present series of 328 patients with severe TBI, 58% had associated trauma, mostly in the skeletal system. The presence of one single associated trauma had no additional effect on rehabilitation as evaluated by actual work placement. In contrast, multiple lesions were liked with a less favourable outcome, probably due to a greater severity of the initial CNS damage. Disturbances in the various information-acquiring systems (e.g. disturbances in eye movements, visual field defects and severe bilateral auditory deficits) were associated with poor outcome. Presence of peri-articular new bone formation and communicating hydrocephalus, usually associated with prolonged periods of unconsciousness, indicated a poor rehabilitation outcome as well.

Abdominal Injuries↗
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Time-related sequelae of TBI in patients with prolonged post-comatose unawareness (PC-U) state.

Seventy-two patients who were in a post-comatose unawareness state for periods longer than 1 month following traumatic brain injury recovered consciousness thereafter. The incidence of residual sequelae of brain trauma in relation to duration of unawareness was studied. The incidence of motor disability, communication disorders, cognitive disturbances and malbehaviour was studied in the patients recovering consciousness after 1, 2, 3 and 6 months. It was found that no significant differences were found in the incidence of the above-mentioned residual sequelae of brain-damaged patients in relation to duration of post-comatose unawareness. However, 76.1% (51/67) of the patients who recovered consciousness and survived the first year following injury were living at home. Most of these were patients who recovered consciousness within the first 3 months following trauma. None of the patients who were in post-comatose unawareness longer than 6 months did so, Five patients (6.9%) died during the first year. Motor disability, independence in activities of daily living, vocational outcome and place of living were significantly related to duration of prolonged unawareness state whereas the disturbances in high mental functions did not. Although the vocational outcome of patients with post-comatose unawareness is not good, the fact that most of them are still able to live at home, having an acceptable quality of survival, justifies, according to our experience, the comprehensive rehabilitation programme.

Activities of Daily Living↗
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Somatosensory evoked potentials in prolonged postcomatose unawareness state following traumatic brain injury.

Somatosensory evoked potentials (SEPs) were found by several authors to have a prognostic value in traumatically brain-injured (TBI) patients and can serve for monitoring changes in the state of TBI patients. Most of the studies were performed in the acute phase of trauma and most of reports have dealt with the short-latency components. The present study reports on seven patients (mean age 26.2 years) who suffered severe blunt TBI and were in prolonged post-comatose unawareness (PCU) state, in whom early and late SEP components were recorded at least 5 weeks after sustaining trauma. The SEPs studied could not reveal a uniform pattern apart from prolonged central conduction time (CCT), which was common to all patients. This may be due to individual non-homogeneous patterns of brain damage in our severe TBI patients. Meaningful late recovery of consciousness occurred in one patient and correlated with shortening of CCT. We suggest that the prolonged CCT found in our patients is related to diffuse subcortical axonal injury and that the shortened CCT found during the second examination in this patient actually reflects late partial recovery--either structural or functional--of affected brain regions. This patient is also an example of the possible relationship between reduction of CCT and recovery of consciousness a long time after injury.

Activities of Daily Living↗
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Biopercular lesions and acquired mutism in a young patient.

A 13-year-old patient developed complete mutism and buccofacial apraxia following toxic vasculitis due to a yellow scorpion sting. Language functions were preserved. A CT scan disclosed mainly biopercular infarcts. It is suggested that the lost control of vocalization and speech is associated with biopercular lesions and that a preserved right opercular region can take over this function in the presence of damage to homologous left opercular region.

Adolescent↗
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Acceptance of disability, work involvement and subjective rehabilitation status of traumatic brain-injured (TBI) patients.

A follow-up of 78 TBI patients one to two years after discharge from rehabilitation hospital supported hypothesized correspondence between work involvement and subjective rehabilitation status (SRS). Subjective rehabilitation was defined as the gratification of basic needs: physical well-being, emotional security, and family, social, economic, and vocational needs. Highest SRS was found among patients employed in the open market. Lower SRS was found in patients employed under protected conditions who also reported their work to be much less congruent with their expectations. Unemployed patients living active lives reported higher SRS than unemployed patients living passive lives, but both showed lower SRS than employed patients. Both work involvement and SRS were found to be related to acceptance of disability (AD). However, longitudinal data are needed to ascertain whether AD precedes or follows the other two variables. Both possibilities may be correct.

Activities of Daily Living↗
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Epidemiological findings in traumatic post-comatose unawareness.

We have examined the epidemiological background of 134 consecutive patients admitted to our centre who suffered from post-traumatic unconsciousness of over 1 month's duration. The incidence of such unconsciousness in Israel is estimated as 4 per 1,000,000, or one case in 410 hospitalizations for head trauma. The cause of trauma was a road accident in 69% of cases. Among victims, pedestrians and cyclists were more likely than four-wheeled vehicle drivers and their passengers to suffer from prolonged unconsciousness, from which they were less likely to recover.

Accidents, Traffic↗
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Impersistent execution of saccadic eye movements after traumatic brain injury.

A dynamic scoring system was developed to quantitatively resolve the ability of a subject to persistently execute a repeated motor act. Saccadic eye movements in response to pseudo-random and periodic stimuli were examined in patients with traumatic brain injury (TBI) and in normal subjects. Results indicated significantly lower dynamic persistence scores for the former group (50.5 +/- 32.2% vs 94.1 +/- 4.4%). Analysis of the patients' data revealed a stronger association of low scores with right hemisphere damage than with left hemisphere damage (39.4 +/- 28.9% vs 76.6 +/- 15.6%). Results are interpreted in terms of high-level attention impairments, not in terms of specific deficits in eye movement ability.

Adolescent↗
PubMedDate not supplied

Electrophysiological findings in poliomyelitis patients at the subacute phase.

Electrodiagnostic tests-needle EMG, nerve conduction and somatosentory evoked potential (SEP) studies of the upper and the lower limbs were performed in three patients during the subacute phase of poliomyelitis. Although poliomyelitis is traditionally considered a "pure motor" disease, involvement of the sensory system was demonstrated by prolonged sensory nerve conduction and by delayed latencies and amplitude asymmetries of SEPs obtained from the lower limbs. Sensory deficit in poliomyelitis is well known to exist during the acute phase of illness. The present report describes the electrophysiological findings in patients during the subacute phase, several months after onset of illness. Sensory nerve action potentials and sensory evoked potentials were abnormal, especially those elicited by lower limb stimulation although the patients had no overt signs of sensory loss at that time. The associated EMG findings are described, and the probable pathologic changes of the motor unit are discussed.

Adolescent↗
PubMedDate not supplied

Treatment of femoral fractures in patients with craniocerebral injury.

9.4% of the patients sustaining cranio-cerebral injury also suffer from femoral fractures. Only those patients who undergo operation and internal fixation during the first week either by nailing or plating recover completely without any orthopedic disability. Conservative treatment or late orthopedic surgical intervention almost always resulted in permanent locomotor disability. It is concluded that early surgical intervention by either nailing or plating of femoral fractures helps in nursing, prevents deformity and leads to the complete recovery of these fractures in patients suffering from concomitant cranio-cerebral injuries.

Adolescent↗