phenylephrine-hydrochloride and Cognition-Disorders

To analyze the indications and outcomes of open neurosurgical approaches (ONA) and endoscopic transnasal approaches (ETA) in the surgical management of pediatric sinogenic subdural and epidural empyema.. Retrospective single-center study design within a tertiary care referral center setting. Children less than 18 years of age consecutively operated on between January 2012 and February 2014 for drainage of a sinogenic subdural empyema (SE) or epidural (EE) empyema were included.. success of first surgical procedure, persistent symptoms and sequelae at the end of the follow-up period.. Nine SE (53%) and 8 EE (47%) were observed. Neurological symptoms, especially seizures, were more frequent in the SE group. Perioperative pus samples were positive in 67% of the SE group and in 75% of the EE group. The most frequently isolated bacteria belonged to the Streptococcus anginosus group. CT or MR imaging showed that most empyema probably originated from the frontal sinus. However, two cases resulted from an ethmoiditis and one case from a Pott's puffy tumor, without any direct contact with the paranasal sinus. In cases of SE, the most effective surgical technique was ONA with craniotomy. Associated endoscopic sinus drainage was useful for the purpose of bacteriological diagnosis. In cases of EE, effectiveness was noted in both ONA and ETA techniques. In two cases of EE, the ETA procedure encompassed direct drainage of the empyema through the posterior wall of the frontal sinus (Draf III approach). The number of patients successfully treated after a single surgical procedure was higher in the EE group (p=0.05). Regarding outcomes, no mortalities were observed. Persistent disorders at the end of the follow-up period, especially headaches, cognitive, concentration or schooling problems, tended to be more frequent in the SE group than in the EE group (67% vs 29%), and were more commonly observed in cases requiring several surgical procedures (75% vs 12.5%) (p=0.05).. Endoscopic sinus surgery plays a critical role in the surgical management of pediatric sinogenic SE and EE. In cases of small volume EE, the endoscopic approach associated with antibiotherapy may be sufficient to treat the infectious process.

Topics: Adolescent; Child; Cognition Disorders; Craniotomy; Drainage; Empyema, Subdural; Endoscopy; Epidural Abscess; Ethmoid Sinusitis; Female; Frontal Sinusitis; Headache; Humans; Learning Disabilities; Male; Nose; Radiography; Retrospective Studies; Streptococcal Infections; Streptococcus anginosus

In this paper, a 3D computer vision system for cognitive assessment and rehabilitation based on the Kinect device is presented. It is intended for individuals with body scheme dysfunctions and left-right confusion. The system processes depth information to overcome the shortcomings of a previously presented 2D vision system for the same application. It achieves left and right-hand tracking, and face and facial feature detection (eye, nose, and ears) detection. The system is easily implemented with a consumer-grade computer and an affordable Kinect device and is robust to drastic background and illumination changes. The system was tested and achieved a successful monitoring percentage of 96.28%. The automation of the human body parts motion monitoring, its analysis in relation to the psychomotor exercise indicated to the patient, and the storage of the result of the realization of a set of exercises free the rehabilitation experts of doing such demanding tasks. The vision-based system is potentially applicable to other tasks with minor changes.

Topics: Artificial Intelligence; Cognition Disorders; Ear; Eye; Humans; Monitoring, Physiologic; Nose; Psychomotor Performance

Chromosome 22q11.2 deletion syndrome (22q11DS) is associated with numerous and variable clinical manifestations including conotruncal heart abnormalities, palatal anomalies, hypoparathyroidism, immune deficiency, and cognitive deficits. The clinical suspicion of this syndrome is often heightened by the presence of characteristic facial features. A previous report highlighted the under-diagnosis of this condition in African Americans, thought to be related to a paucity of typical facial features. We ascertained the largest cohort (n = 50) of African-American individuals with 22q11DS reported thus far, across five genetics centers in the United States and report on their facial and other phenotypic features. About 3/4 of our cohort has at least one dysmorphic facial feature. Auricular abnormalities, especially small ears, are the most common dysmorphic facial feature followed by nasal and ocular abnormalities. Skeletal findings are seen in about 2/3 of our cohort, higher than the typical frequency reported in 22q11DS. Cardiac anomalies, developmental delay, and palatal abnormalities are seen at a lower frequency in our cohort. Thus, it is evident that the features traditionally associated with 22q11DS are difficult to recognize in African-American individuals with this syndrome, due to both altered frequencies of major anomalies and a non-classic facial appearance. Therefore, a high index of suspicion is needed to recognize 22q11DS in African-American individuals.

Topics: Abnormalities, Multiple; Adolescent; Adult; Aged; Black or African American; Child; Child, Preschool; Chromosome Deletion; Chromosomes, Human, Pair 22; Cognition Disorders; Cohort Studies; Ear; Eye Abnormalities; Facies; Female; Heart Defects, Congenital; Humans; Hypoparathyroidism; Immune System Diseases; Infant; Male; Middle Aged; Nose; Phenotype; Retrospective Studies

Topics: Child; Cognition Disorders; Humans; Malocclusion; Maxillofacial Development; Mouth Breathing; Nasal Obstruction; Nose; Sleep Wake Disorders

Neurotrophic ulceration of the face is a rare but well recognized sequel to division of the trigeminal nerve. Trauma is an important contributory factor and thought to be due in part to paraesthesiae, which encourages picking and scratching, with resultant chronic and persistent ulceration. A case is described of an 82-year-old woman with severe trigeminal neurotrophic ulceration which improved substantially with pimozide, given for treatment of unrelated paranoid symptoms. The possible relevance of this to the established use of pimozide in delusional parasitosis is briefly discussed.

Topics: Aged; Aged, 80 and over; Atrophy; Cognition Disorders; Facial Dermatoses; Female; Humans; Nose; Pimozide; Skin Ulcer; Trigeminal Nerve

Topics: Aged; Cognition Disorders; Humans; Intubation, Gastrointestinal; Methods; Nose; Pharynx