SPECT, CT, and MRI in head injury: acute abnormalities followed up at six months

We report a case of cervicofacial necrotizing fasciitis that developed after blepharoplasty, an occurrence that, to our knowledge, has not previously been reported in the medical literature. A patient who presented to our institution 3 days after undergoing blepharoplasty of the upper eyelid was diagnosed as having fulminant fasciitis involving extensive areas of the face, scalp, and neck. We review the case in detail and discuss clinical and radiological clues to diagnosis, surgical and medical management, wound care, and subsequent scar contracture. This case emphasizes the need for individualized, appropriate postoperative care and for an awareness of this rare, potentially fatal complication. Early recognition and aggressive treatment of cervicofacial fasciitis can arrest its rapid progression and prevent devastating sequelae.     

Rumination and overgeneral memory in depression: Effects of self-focus and analytic thinking.

Previous research has shown that, compared with a rumination induction, a brief distraction procedure reduces overgeneral autobiographical memory in depression. The authors investigated whether this effect depends on reductions in analytic thinking or reductions in self-focus. Focus of attention (high vs. low self-focus) and thinking style (high vs. low analytical thinking) were independently manipulated in depressed patients in a 2 X 2 design. Autobiographical recall was measured pre- and postmanipulation. Thinking style significantly affected overgeneral memory, whereas focus of attention significantly affected despondent mood. Reducing analytical self-focus reduced overgeneral memory, suggesting that high levels of naturally occurring ruminative analytic thinking may be important in the maintenance of overgeneral memory. Overgeneral memory in depression may be associated with chronic ruminative attempts to make sense of current or past difficulties. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investigation of the Heterogeneity of Disruptive Behaviour in Elementary-Age Children.

We evaluated parent and teacher ratings of a large sample (N=1579) of elementary-school children in Canada to determine how different conceptualizations of disruptive behaviour are co-related and related to other measures of functioning. Parent and teacher ratings were consistent, and suggested three separate but correlated aspects of disruptive behaviour in children: (1) reactive/oppositional behaviour, (2) proactive/callous behaviour; and (3) inattention-impulsive-overactive behaviour. These were uniquely and significantly related to DSM-IV diagnostic scores and to other measure of impairment, indicating that they measure distinct aspects of disruptive behaviour in children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preferences of therapists-in-training for client characteristics.

The preferences of 132 therapists-in-training for 16 client characteristics were investigated using a paired comparison methodology. Therapists most preferred to work with clients who were psychologically minded, shared similar attitudes and values, and had dissimilar personally troubling problems. They least preferred to work with clients who were not psychologically minded, had dissimilar attitudes and values, and were older. Order of preferences was not influenced by therapist sex, race, clinical experience, socioeconomic status, sexual orientation, or theoretical orientation. Limitations of this study as well as implications for further research and training are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Assessing disability after head injury: improved use of the Glasgow Outcome Scale

OBJECTIVE: The objective of this study was to assess somatic and inherited androgen receptor gene mutations in families with only one affected individual. METHODS: Molecular genetic analysis of the androgen receptor gene in DNA derived from blood leukocytes from 30 families with single-strand conformation analysis, direct sequencing, and restriction fragment analysis was performed. RESULTS: In 22 families the mothers and all investigated grandmothers were heterozygous carriers. However, within the sisters and aunts, both heterozygous carriers and noncarriers were present. In eight families a de novo mutation was characterized. In three of these patients indication for somatic mosaicism was found. CONCLUSIONS: De novo mutations occur at a high rate within the androgen receptor gene (8 of 30 = 26.7%); a high proportion (3 of 8) arise after the zygote stage. Thus only direct analysis of the underlying mutation of the androgen receptor gene in the proband and his or her family can provide the basis for genetic counseling.     

Attentional demands and the organization of reaching movements in rock climbing

Epiphrenic oesophageal diverticula are of the pulsation type, the underlying cause is a motility disorder. Resection is indicated by severe symptoms like dysphagia, regurgitation or aspiration and should be performed after endoscopic dilatative treatment of the neuromotor disturbance. Thoracoscopic resection under endoluminal endoscopic surveillance is considered to be a reliable procedure with low morbidity for the patient.     

Craniocerebral trauma: protection and retrieval of the neuronal population after injury

OBJECTIVE: To review the consequences of mechanical injury to the brain with an emphasis on factors that may explain the variability of outcomes and how this might be influenced. METHODS: Information regarding the pathophysiology of traumatic brain damage contained in original scientific reports and in review articles published in recent years was reviewed from the perspective of a clinical neurosurgeon and a neuropathologist, each with major research interests in traumatic brain damage. The information was compiled on the basis of the knowledge of and personal selection of articles that were identified through selective literature searches and current awareness profiles. A systematic literature review was not conducted. RESULTS: Mechanical input affects neuronal and vascular elements and is translated into biological effects on the brain through a complex series of interacting cellular and molecular events. Whether these lead to permanent structural damage or to resolution and recovery is determined by the balance between processes that, on the one hand, mediate the effects of initial injury and subsequent secondary insults and, on the other, are manifestations of the brain's protective, reparative response. Experimental and clinical research has identified opportunities for altering the balance in a way that might promote recovery, but data demonstrating that this can lead to substantial clinical benefit are lacking. Recent evidence of genetically determined, individual susceptibility to the effects of injury may explain some of the puzzling variability in outcome after apparently similar insults and may also provide new opportunities for treatment. CONCLUSION: The understanding of traumatic brain damage that is being gained from recent research is widening and broadening perspectives from the traditional focus on mechanical, vascular, and metabolic effects to encompass wider, neurobiological issues, drawn from the fields of neurodevelopment, neuroplasticity, neurodegeneration, and neurogenetics. Neurotrauma is a fascinating area of neuroscience research, with promise for the translation of knowledge to improved clinical management and outcome.     

Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use

The Glasgow Outcome Scale (GOS) is the most widely used outcome measure after traumatic brain injury, but it is increasingly recognized to have important limitations. It is proposed that shortcomings of the GOS can be addressed by adopting a standard format for the interview used to assign outcome. A set of guidelines are outlined that are directed at the main problems encountered in applying the GOS. The guidelines cover the general principles underlying the use of the GOS and common practical problems of applying the scale. Structured interview schedules are described for both the five-point GOS and an extended eight-point GOS (GOSE). An interrater reliability study of the structured interviews for the GOS and GOSE yielded weighted kappa values of 0.89 and 0.85, respectively. It is concluded that assessment of the GOS using a standard format with a written protocol is practical and reliable.     

Directional control of rapid arm movements: The role of the kinetic visual feedback system.

Examined how vision of initial, terminal, or complete arm trajectory affected the movement control and accuracy of 6 right-handed volunteers when the amplitude and directional task constraints were varied. Evidence was found for the significant contribution of vision during the initial phase of rapid pointing movements when this phase is under the control of the kinetic channel. Movements having directional requirements were more accurate when vision of the initial portion of the trajectory was available. Times-to-peak acceleration and velocity were shorter and their respective amplitudes were generally higher when vision was available for the 1st 3rd of the trajectory than when it was not. Vision of the entire trajectory did not yield better precision than when vision was available for the initial phase of the movements only. The data support the existence of 2 supportive visual feedback systems. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)