Intramuscular injection as a provoking factor for paralysis in acute poliomyelitis. A case control study

In order to identify the role of intramuscular injection (IM) as a provoking factor for poliomyelitis, a case control study as done at the Institute of Child Health, Madras from May 1988 to May 1989. The case was defined as acute poliomyelitis if he had acute asymmetric flaccid paralysis of lower motor neurone type without objective sensory disturbance following a short episode of fever. Controls were taken from children attending outpatient department for fever. Two controls matched for aged and sex were recruited for each case. Recruitment, data collection and clinical examination were done by a single pediatrician. IM injection received within 30 days prior to onset of paralysis or illness was considered to be the risk factor. The total number of cases and controls recruited were 257 and 515, respectively. Among cases, 172 (66.9%) out of 257 and among controls 252 (48.9%) out of 515, received IM injection within one month earlier to onset of paralysis or illness. The overall risk of paralysis, estimated for IM injection, was increased [odds ratio (OR) 2.1 (95% CI, 1.5-3.0)]. The maximum risk for paralysis was observed to be 2 weeks preceding the illness; the ORs for < 7 days was 2.2 (95% CI, 1.6-3.2) and for 7-13 days 3.2 (95% CI, 1.8 to 5.8). The risk of paralysis associated with IM injection was similar for unimmunized and immunized cases (OR 2.4 and 2.2). Multiple injections were not associated with a higher risk of developing paralysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

The pattern of residual muscle paralysis in poliomyelitis

Rural schoolchildren between the ages of 6 and 18 years were screened for residual paralysis following poliomyelitis; 503 (0.85%) out of a total of 58,592 were victims. Of these, only 16 (3.8%) had received poliomyelitis vaccine, while the remainder had not been immunised. The disease had occurred before the age of 4 years in nearly 90%, the lower limbs being affected (98%) more often than the upper (2%). In the lower limbs, the quadriceps, hip adductors and tibialis anterior were frequently affected. The muscles supplied by the L4 and L5 spinal segments were most commonly involved, while those supplied by L1 and S3 were least. Some order does exist in the apparently irregular distribution of paralysis after poliomyelitis.     

Role of provocation poliomyelitis in vaccine-associated poliomyelitis

BACKGROUND: Laparoscopic gastrostomy as an alternative to open gastrostomy was introduced with various technical variants 5 years ago. However, long-term results of these new methods are still lacking. METHODS: From 4/1993 to 2/1996, laparoscopic gastrostomies were performed on 42 patients (50.9 +/- 15.6 [24-71] years) with esophageal stenosis in locally advanced hypopharyngeal (17 patients) or oropharyngeal (nine patients) carcinoma, incurable esophageal carcinoma (13 patients) and cerebral dyspagia (three patients). Operating time was 38 +/- 11 min [15-65 min]. Procedure-related mortality was 0%. Major complications occurred in 2/42 (4.7%) patients; minor complications were found in 4/42 (9.4%) patients. During a total usage time of 427 months, 14 stoma infections occurred (0.11 infections/100 days). CONCLUSION: Laparoscopic gastrostomy allows a safe, fast, and cheap reestablishment of enteral nutrition. The procedure is minimally invasive and can also be performed under local anesthesia. It has become our method of choice in patients with malignant, nonresectable subtotal stenosis of the hypopharynx or esophagus.     

Vocal cord laterofixation as early treatment for acute bilateral abductor paralysis after thyroid surgery

Bilateral vocal cord palsy due to a lesion of the recurrent laryngeal nerves is a serious complication of thyroid operations, with the airway obstruction usually necessitating tracheostomy. In the cases presented, a stable airway was ensured with endolaryngeal cord laterofixation instead of tracheostomy. The operation was performed with the endo-extralaryngeal needle carrier instrument devised by Lichtenberger. During the operation, only minor surgical trauma occurred in the larynx. The fixing thread was then removed following recovery of contralateral vocal cord function, resulting in an improvement in the voice. Four patients are described who suffered bilateral recurrent laryngeal nerve palsy after thyroid gland operations. During the follow-up period of 3-12 months, airway stability was demonstrated by regular spirometric measurements. The simple method recommended spares patients the possible complications of tracheostomy.     

A prospective clinical and electrophysiologic survey of acute flaccid paralysis in Chinese children

We studied 29 children admitted to Beijing Children's Hospital (BCH) with acute flaccid paralysis between June 1991 and June 1993. Twenty-seven patients had Guillain-Barré syndrome--7 with acute inflammatory demyelinating polyneuropathy and 20 with acute motor axonal neuropathy (AMAN). Two had poliomyelitis. The most common cause of acute flaccid paralysis at BCH is the AMAN pattern of GBS.     

A case of acute pulmonary edema and bulbar paralysis after local epinephrine infiltration

A cataract developed in a 23-year-old man 4 months after a vitrectomy to repair a traumatic retinal detachment. An uneventful phacoemulsification was performed, using antibiotic-fortified infusion solution. Afterward, a large area of atrophic retina, consistent with gentamicin toxicity, was observed in the macula. The patient remains stable with 20/200 best-corrected acuity. The authors suggest that because the vitreous had been removed, gentamicin was able to settle over the macula during the entire cataract procedure. Therefore, gentamicin should be used intracamerally with caution, especially in eyes in which vitrectomy has been performed.     

Validation of objective measures for facial paralysis

A shift from subjective scales to objective measures of facial paralysis requires physical models against which to validate and calibrate the new objective techniques. The purpose of this report was to demonstrate such a model and to test the capacity of an objective computer system to accurately measure physical change. The physical model consisted of an advancing edge of a spreading gelatin film. The model was measured in submillimeter increments. Concurrent measurements were made using the computed system. Ten trials were conducted. The objective system proved to be exquisitely sensitive (0.03 mm) and highly correlated with the physical criterion model (Pearson's product moment correlation coefficient [r]=0.9849). Sensitive and calibrated objective methods of analysis of facial motion are crucial to the design of clinical trials, clinical studies of nerve regeneration, and comparisons of reanimation techniques.     

Diphtheria and poliomyelitis incidence in Europe

Measurements are presented of angular velocities of rotation of mammalian cells of K562 (human) and SP2 (mouse) in external alternating electric fields over a frequency range of 0.5 kHz to 12 MHz. Electro-rotation of the cells was observed for the case of "two cells in contact' using two parallel, cylindrical electrodes; only one cell was located on the electrode. A theoretical analysis is also presented which shows that the cell rotation arises from a torque produced by the interaction between the primary electric dipole moment induced in the spinning cell and the secondary electric fields, generated by the primary dipole induced in the adjacent cell. These secondary fields are out of phase with the applied electric field. The results show that (a) only the cell not located on the electrode rotates, (b) maximal electro-rotation occurs at two different excitation field frequency domains for the frequency range employed here, (c) the spin speed of the rotating cell at each frequency domain is much less than the excitation frequency, (d) the rotation direction of the cell depends on the angle (theta) between the external electric field and the line joining the centres of the two cells and (e) for a given angle theta, the rotation direction is the same for both excitation frequency domains. The experimental measurements allowed us to estimate the conductivities of the cytoplasms and membrane capacitances of the cells of K562 and SP2. The conductivities of the cytoplasms of the cells of K562 and SP2 were estimated to be 0.2 and 0.3 Sm-(1), respectively, whereas the membrane capacitances of these cells were found to be 2.7 +/- 0.8 and 9.8 +/- 0.6 mFm-(2), respectively.     

Cognition and the global Malaria Eradication Programme

When making a decision involves the analysis of complex cause-effect relationships, experts are normally consulted to describe the best options available. The global Malaria Eradication Programme relied upon the advice of a small group of experienced malariologists; their counsel directed the most ambitious endeavour in the history of the World Health Organisation. In this essay 1 week to show how that group behaved with a single purpose and ultimately grew to be greater than the sum of its parts because of the control of knowledge. Each member of this epistemic community was willing to battle against malaria as soon as possible--forsaking research, traditional tools, and risking disastrous epidemics--because they believed that residual insecticides could progressively eradicate a disease that killed millions and sapped the lives of countless more. Alternative methods were ridiculed; and the epistemic community used their individual prestige to insert the DDT gospel into the technical forums of the WHO, and the power (and money) forums of the USA. Particular knowledge structures of the post-war decade nurtured a technical solution to malaria, and we shall explore how the WHO and the epistemic community could grow within this environment so compatible to their praxes.     

Body-image boundaries and adjustment to poliomyelitis.

In a group of 56 polio patients, a relationship between psychological adjustment to physical handicap and a measure of body-image boundaries was shown to exist. "Apparently, individuals who conceive of their body boundaries as possessing defensive, armoring, barrier-like qualities are significantly better able to adapt to the circumstances surrounding physical loss than are those individuals whose body concept does not contain these features." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outbreak of paralytic poliomyelitis in Namibia

The last confirmed case of poliomyelitis in Namibia had been reported in 1988. However, between Nov 8, 1993, and Jan 7, 1994, 27 cases of paralytic poliomyelitis were confirmed in the country. The outbreak was limited to the south health region; at least 80% of infants in this region have received four doses of oral poliovaccine (OPV) by the age of 1 year. Acute flaccid paralysis (AFP) was the predominant clinical presentation during the outbreak. The patients' ages ranged from 13 months to 12 years; 24 were younger than 5 years. Of the 26 patients whose vaccine status was known, 14 had received four doses of OPV, 6 had one or two doses, and 6 no vaccine. Genotypic analysis showed 86% homology of outbreak isolates with a 1982 Namibian isolate and west African isolates. Factors that may have had a role in the outbreak include establishment of a pool of susceptible people, rapid urbanisation, inadequate sanitation, poor water supply, and possible endemicity of poliovirus in neighbouring areas. Epidemics can occur in areas of high vaccine coverage. Our findings emphasise the need to improve AFP surveillance activities and the estimation of vaccine coverage to identify areas of potential susceptibility for outbreaks.     

Serial MRI findings of benign poliomyelitis

Clinical and electrodiagnostic evaluations were performed in 25 patients with electric burns who were injured 2 to 13 years before the study. Abnormal motor nerve conduct findings were detected in 12 of the patients. In nine patients, abnormalities were observed in more than one nerve. There was a positive relation noted between age and nerve lesions. Weakness was the most prominent clinical finding.