Cerebral Palsy

OBJECTIVE:: To estimate changes in levator hiatal dimensions after childbirth in women with and without ultrasonographically visible morphological abnormalities of the levator ani and to correlate those changes with delivery mode. METHODS:: A total of 296 nulliparous women were recruited. They were examined with four-dimensional translabial ultrasonography at 36-38 weeks of gestation and at 3-4 months postpartum. Peripartal changes in levator hiatal dimensions were correlated with delivery data. RESULTS:: Mean postpartum follow-up was 5.3 months (median 4.1, interquartile range 3.7 to 5.1). Of 212 women who returned for follow-up, 101 had had normal vaginal deliveries (48%), 31 vacuum/forceps (15%), and 80 cesarean deliveries (38%). After cesarean delivery, there was a decrease in the mean hiatal area on Valsalva maneuver of 8.5% (P=.005). Vaginal delivery without avulsion was associated with an increase of 6% (P=.035). In women with avulsion injury, hiatal area increased by 28% (P=.002). Mean postpartum hiatal area on Valsalva was 25.46 cm after vaginal delivery with avulsion, 22.61 cm without avulsion, and 19.13 cm in the cesarean delivery group. After avulsion, hiatal area on contraction also increased significantly (P<.001). CONCLUSION:: Vaginal childbirth results in enlargement of the levator hiatus, especially after an avulsion. However, even without macroscopic levator trauma, there may be increased distensibility of the hiatus, which may be another mechanism leading to enlargement of the hiatus and pelvic organ prolapse. LEVEL OF EVIDENCE:: II.

The incidence of schizophrenia in the general population ranges from about 1% to 2%. Schizophrenia affects men and women equally, occurring in all cultures and socioeconomic classes. The peak age of onset in women is 25 to 35 years, which are also the peak childbearing years, and women with psychotic illnesses are likely to have more unplanned pregnancies than women without a psychotic illness. Not only are antipsychotic medications prescribed for schizophrenia, but, especially since the introduction of the second-generation (atypical) antipsychotics, these drugs are also used to treat other psychiatric illnesses such as bipolar disorder. As a result, there is an increase in the number of women requiring antipsychotic drug therapy who are likely to become pregnant. It is important to evaluate the safety of these drugs in pregnancy, as most women with a serious psychiatric illness cannot stop taking their medication, as this would interfere with their activities of daily living, especially taking care of an infant. In this review, we describe available up-to-date, evidence-based information regarding the safety of antipsychotic drugs that are currently used in pregnancy. These include first-generation (conventional) antipsychotics (eg, promethazine, chlorpromazine, prochlorperazine, haloperidol, perphenazine, trifluoperazine, loxapine, thioridazine, flupenthixol, fluphenazine) and second-generation antipsychotics (eg, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, paliperidone). To date, no definitive association has been found between use of antipsychotics during pregnancy and an increased risk of birth defects or other adverse outcomes. However, there is a paucity of information, with a lack of large, well designed, prospective comparative studies. The information presented here should therefore not be interpreted as conclusive with regard to the safety of these drugs, as more research is needed. Women who require treatment should always discuss the risks and benefits of pharmacotherapy with their physician and, if it is felt that treatment should be continued during pregnancy, the evidenced-based information presented here will be of help in this important decision.

OBJECTIVE: To summarize the current literature regarding the significant prevalence and potential consequences of sleep disturbance following traumatic brain injury (TBI), particularly mild TBI. DESIGN: PubMed and Ovid/MEDLINE databases were searched by using key words “sleep disturbance,” “insomnia,” “TBI,” “brain injury,” and “circadian rhythms.” Additional sources (eg, abstracts from the annual Associated Professional Sleep Societies meeting) were also reviewed. RESULTS: Sequelae of TBI include both medical and psychiatric symptoms and frequent complaints of sleep disturbance. Sleep disturbance likely result from and contribute to multiple factors associated with the injury, all of which complicate recovery and resolution of symptoms. Interestingly, research now seems to indicate that mild TBI may be more correlated with increased likelihood of sleep disturbance than are severe forms of TBI. CONCLUSIONS: Sleep disturbance is a common consequence of TBI, but much more research is required to elucidate the nature and extent of this relation. Research needs to focus on (1) uncovering the specific types, causes, and severity of TBI that most often lead to sleep problems; (2) the specific consequences of sleep disturbance in this population (eg, impaired physical or cognitive recovery); and (3) the most effective strategies for the treatment of sleep-wake abnormalities in this population.

BACKGROUND AND PURPOSE: CT angiography (CTA) is receiving increased attention in intracerebral hemorrhage (ICH) for its role in ruling out vascular abnormalities and potentially predicting ongoing bleeding. Its use is limited by the concern for contrast induced nephropathy (CIN); however, the magnitude of this risk is not known. METHODS: We performed a retrospective analysis of a prospectively collected cohort of consecutive patients with ICH presenting to a single tertiary care hospital from 2002 to 2007. Demographic, clinical, and radiographic data were prospectively collected for all patients. Laboratory data and clinical course over the first 48 hours were retrospectively reviewed. Acute nephropathy was defined as any rise in creatinine of >25% or >0.5 mg/dL, such that the highest creatinine value was above 1.5 mg/dL. RESULTS: 539 patients presented during the study period and had at least 2 creatinine measurements. 348 (65%) received a CTA. Acute nephropathy developed in 6% of patients who received a CTA and in 10% of those who did not (P=0.1). Risk of nephropathy was 14% in those receiving no contrast (130 patients), 5% in those receiving 1 contrast study (124 patients), and 6% in those receiving >1 contrast study (244 patients). Neither CTA nor any use of contrast predicted nephropathy in univariate or multivariate analysis. CONCLUSIONS: The risk of acute nephropathy after ICH was not increased by use of CTA. Studies of CIN that do not include a control group may overestimate the influence of contrast. Patients with ICH appear to have an 8% risk of developing "Hospital-Acquired Nephropathy."

Embryo sacs of the Korean salamander, Hynobius leechii, were collected from nine farmlands in Gyeongsangnam-Do, Korea, in early spring of 2002 and 2004. The variations in the number of embryos within each embryo sac and the mortality and abnormality rates among the embryos were investigated. We also analyzed the patterns of spontaneous embryonic malformations and the residual chemicals in the soil of the habitats using multiple-residue GC/MS. A total of 79,195 embryos were obtained from 1933 embryo sacs. There were regional variations in the length of individual embryo sacs and the number of embryos in each. The longest embryo sac averaged by region measured 20.67 (cm) +/- 3.51 and was obtained from 2-Banseong in 2002. Of the embryos collected, 13.71% either died or stopped developing, and 3.54% of the hatched embryos developed abnormally; the latter were classified according to the patterns of malformation. External gill dysplasia was the most frequent malformation, and caudal dysplasia, abdominal blisters, and dysplasia of the fin were also observed frequently. Histopathological analysis showed neural tube abnormalities, acrania, curved notochords, thyroid teratoma, and various other kinds of endodermal developmental abnormalities. In the analysis of the residual pesticides in the soil, carbofuran, endosulfan-sulfate, and endosulfan-beta were detected in the regions with high mortality and malformation rates. These results indicate that various agricultural chemicals and other unknown factors may cause the aforementioned forms of spontaneous malformations in the embryos of Hynobius leechii. (c) 2009 Wiley Periodicals, Inc. Environ Toxicol 2009.

Our objective was to evaluate whether thrombocytopenia and small thymus volume, which may be associated with hazardous alcohol consumption, are predictors of cognitive performance after highly-active antiretroviral treatment (HAART). To achieve this goal 165 people living with HIV starting HAART underwent thymus magnetic resonance imaging, cognitive (HIV Dementia Score [HDS] and the California Verbal Learning Test [CVLT]), immune and laboratory assessments at baseline and after 6 months of HAART. At baseline, hazardous alcohol consumption was significantly correlated with both thymus size (r = -0.44, p = 0.003) and thrombocytopenia (r = 0.28, p = 0.001). Of interest, thrombocytopenic patients were characterized by a smaller thymus size. Individuals with and without cognitive impairment differed in alcohol consumption, platelet counts and thymus size, suggesting that they may be risk factors for neurological abnormalities. In fact, after HAART hazardous alcohol use associations with thrombocytopenia were related to cognitive decline (learning = -0.2 +/- 0.8, recall = -0.3 +/- 0.1 and HDS = -0.5). This contrasted with improvements on every cognitive measure (learning = 1.6 +/- 0.3, p = 0.0001, recall = 2.2 +/- 0.4, p = 0.0001 and HDS = 1.0, p = 0.05) in those with neither alcohol use nor thrombocytopenia. In adjusted analyses for sociodemographics, adherence and immune measurements, reduced thymus size was associated with a 90% and thrombocytopenia with a 70% increase in the risk of scoring in the demented range after HAART (RR = 1.9, p < 0.05 and RR = 1.7, p = 0.03) and with low CVLT scores (thymus volume RR = 2.0, p = 0.04, chronic alcohol use p = 0.05 and thrombocytopenia p = 0.06). Thymus volume and platelet counts were negatively affected by alcohol and were predictors of cognitive performance and improvements after HAART. These results could have important clinical and therapeutic implications.

Bernard-Soulier Syndrome (BSS) is an inherited recessive bleeding disorder. In some instances, diagnosis might be restricted to routine blood exams, including bleeding time, prothrombin time (PT), and partial thromboplastin time (APTT). Exams such as platelet aggregation, and testing for expression of ristocetin cofactor, or von Willebrand factor may not be commonly performed. This leads to misdiagnosis in a number of patients, which are subsequently treated erroneously. Flow cytometry has been used widely as a tool in the diagnosis of leukemias, lymphomas, and many other immuno-hematological diseases. The purpose of this study was to assess whether flow cytometry could be helpful in the diagnosis of Bernard-Soulier Syndrome in Brazilian patients. For this, we examined a selected group of 15 patients with suspected BSS based on classical diagnosis. We used a panel of antibodies to detect the expression of glycoproteins GPIbalpha, GPIIb, GPIIIa, GPIX, as well as CD9. Abnormalities of GPIb and GPIX were observed in nine of the 15 patients, which included severe reduction of both antigens, of one or the other, or normal levels but weak expression. Strikingly, this abnormality correlated with severely reduced expression of CD9 in all cases. We discuss the implications for flow cytometric diagnosis of BSS.

Patients with functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia, and noncardiac chest pain, can suffer from a range of severe symptoms that often substantially erode quality of life. Unfortunately, these conditions are notoriously difficult to treat, with many patients failing to improve despite being prescribed a wide variety of conventional medications. As a consequence, the potential benefits of hypnotherapy have been explored with evidence that this approach not only relieves symptoms but also appears to restore many of the putative psychological and physiological abnormalities associated with these conditions toward normal. These observations suggest that this form of treatment has considerable potential in aiding the management of functional gastrointestinal disorders and should be integrated into the ongoing medical care that these patients are receiving.

Alcohol-exposed pregnancy is a leading cause of preventable birth defects in the United States. This paper describes the motivational patterns that relate to risky drinking and ineffective contraception, two behaviors that can result in alcohol-exposed pregnancy. As part of an intervention study aimed at reducing alcohol-exposed pregnancy 124 women were recruited and reported demographic characteristics, readiness to change, stages of change, drinking, contraception, and sexual behavior history. Our results showed the following. Drinking: A significant positive correlation was found between the number of drinks consumed in 90 days and the Importance to reduce drinking (r = .23, p = .008). A significant negative correlation between number of drinks and confidence to reduce drinking (r = -.39, p = .000) was found as well. Significant differences were found in the total number of drinks consumed in 90 days between the five stages of change (F = (4,118), 3.12, p = .01). Women in Preparation reported drinking a significantly higher number of drinks than women in other stages of change. Contraception: There were significant negative correlations between ineffective contraception and Importance (r = -.38, p = .00), confidence (r = -.20, p = .02) and Readiness (r = -.43, p = .00) to use contraception effectively. Significant differences in contraception ineffectiveness were found for women in different stages of change (F = (4,115) 8.58, p = .000). Women in Precontemplation reported significantly higher levels of contraception ineffectiveness compared to women in other stages of change. Results show a clear relationship between higher alcohol consumption and higher levels of motivation to reduce drinking. In contrast, higher levels of ineffective contraception were related to lower levels of motivation to use contraception effectively. This suggests risky drinking may be better targeted with brief skills building interventions and ineffective contraception may require interventions that enhance problem awareness and motivation.

OBJECTIVE: To explore leisure participation by people with traumatic brain injury (TBI) and reasons underlying changes after the trauma. PARTICIPANTS: Twenty-six individuals with mild to severe TBI. MAIN MEASURE: Leisure Profile, a semi-structured questionnaire measuring involvement in leisure activities before and after TBI (frequency of activities, degree of interest, and desire to modify one’s leisure activities), attitudes toward leisure, and difficulties that might influence leisure activities (impairments and environmental obstacles). RESULTS: Leisure participation was greatly disrupted after TBI, with 92% of the participants reporting a reduction posttrauma. Less severe injuries, more time since the injury, and the presence of social obstacles in the environment were positively correlated with leisure participation. Motor impairments had a negative impact on leisure participation. CONCLUSION: TBI has a significant negative effect on leisure participation. Leisure activities should be evaluated and included in a therapy program designed to promote reintegration into society and work.