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Biomedical subjects

L Sazbon

Publications and source records attributed to L Sazbon.

35 records · Page 2Linked to original sources
PubMed1984

The diagnostic value of three common primitive reflexes.

Systematic attempts were made to elicit the snout, palmomental and corneomandibular reflexes in 50 young patients with prolonged traumatic coma, 50 elderly hemiplegics soon after their first cerebrovascular accident and in 100 normal age-matched controls. None was found significantly more frequently alone in brain-damaged patients than in age-matched controls. Only combinations of two or three reflexes showed diagnostic value in distinguishing between neurologically damaged patients and normal age-matched controls. Only the combination of all three was completely absent in the normal controls; this combination was found in 13% of the brain-damaged subjects.

Adult↗
PubMed1983

Hypothalamic-pituitary function in patients with prolonged coma.

In eight patients (six males and two females) hospitalized for prolonged coma (164-1320 days; five patients were in traumatic coma, two after cardiac arrest during surgery, and one after a venomous scorpion sting), diurnal variation of cortisol secretion, human (L) GH, PRL, TSH secretion as well as the release of the pituitary hormones after TRH and L-dopa stimulation were assessed. Serum T4 cortisol, hGH, hPRL, and hTSH levels were normal. The cortisol diurnal variation was preserved in six patients. In seven of eight patients, the hPRL and hTSH responses to TRH test were normal and in five patients, there was a rise of more than 150% in serum hGH concentrations. After L-dopa administration, five patients responded with a rise in hGH. In three patients, there was no response of hGH to TRH or L-dopa. Five patients responded with significant reduction in the serum hPRL concentration after L-dopa, and in three patients, no change was observed. It was concluded that patients with prolonged coma have variable hypothalamic pituitary function. They preserve the cortisol diurnal variation and the hypothalamic-pituitary-thyroid axis as well as PRL secretion; however, hGH secretion may respond abnormally to various stimuli.

Adult↗
PubMed1983

Growth hormone and periarticular new bone formation--a causal relationship? A preliminary communication.

In an attempt to examine the relationship between growth hormone (GH) and periarticular new bone formation (PNBF), we studied eight patients with brain lesions of different origins who were in a prolonged comatose state for 164 to 1320 days. Five of them developed PNBF. The latter reacted to both the specific L-Dopa test and to the non-specific TRH test with an increase in GH serum concentration. Those patients who did not develop PNBF, failed to react significantly to either tests. The difference in GH values between the two groups is statistically significant at the 95% level of confidence. We hypothesize that there may be a causal relationship between high concentrations of GH in serum and PNBF.

Adolescent↗
PubMed1981

Widespread periarticular new-bone formation in long-term comatose patients.

Widespread periarticular new-bone formation (myositis ossificans) was studied in 45 patients with brain damage who were in long-term coma. Thirty-six of these patients displayed myositis ossificans around at least one major joint. The development of myositis ossificans was shown to be independent of the sex and age of the patient and also of the aetiology, duration and outcome of the coma. Radiographic evidence first appeared between one and two months after the onset of coma. The maximal spread of myositis ossificans was reached in the first five months after the onset of coma. Progression of the disease was not observed after 14 months. Myositis ossificans was defined as a progressive self-limiting disease found in comatose patients.

Adolescent↗
PubMed1980

The value of electroencephalography in prolonged coma: a comparative EEG-computed axial tomography study of two patients one year after trauma.

Interest was aroused in two patients of 16 and 17 years of age and similar craniocerebral trauma, but who had differing EEG's 1 year after injury while their later situation was the reverse of what the EEG would have led one to expect. The patient with an iso-electric EEG showed clinical improvement during the course of the second year, as indicated by a rise in his Glasgow coma rating from 8 to 11. This patient had marked cortical atrophy with discrete central atrophy, shown by computed axial tomography (CT); the isotope cisternogram showed good peripheral absorption of the isotope and no penetration into the ventricles. The other patient showed diffuse slow-wave activity in his EEG but failed to improve clinically or electroencephalographically. His CT-scan showed marked central and discrete cortical atrophy; his isotopic cisternogram showed penetration of isotope into the ventricles with poor peripheral absorption. These two cases illustrate the hazard of relying on an iso-electric EEG after 1 year of coma as an indicator of brain death, and the value of the CT-scan in the initial assessment of such cases.

Adolescent↗
PubMed1978

Gastrointestinal hemorrhage in long-lasting traumatic coma.

Sixteen cases, aged 19 to 61 years and suffering from traumatic coma were studied for periods varying from 7 to 20 months. Obvious or occult gastrointestinal hemorrhage appeared in every case, the earliest presentation being after a few weeks and the latest at 20 months. Gastric acidity was normal in 15 cases. Five patients had duodenal ulceration in repeated roentgenological examination. Concomitant clinical findings included clubbing and paraarticular new bone formation in 9 patients. In addition, hypoxia with repeated values between 63 and 88 mm was observed in 13 of the 16 patients. The latter observation strongly suggests that hypoxia of gastrointestinal mucosa may, indeed, play a pathogenetic role in gastrointestinal hemorrhage of patients with C.C.I.

Adult↗
PubMed1978

Recovery of communicative functions after prolonged traumatic coma.

Fifteen patients with prolonged coma after craniocerebral injury were observed for a year or more, and their communicative functions were evaluated. Nine of them showed a considerable degree of recovery, while 6 remained in a vegative state. Of the 9 with recovery, 6 showed complete recovery of semantic functions, while 3 remained with aphasic deficits. Eight out of these 9 remained dysarthric. Communicative recovery began as late as 5.7 months after injury, and it roughly paralleled recovery in locomotion and A.D.L. Restlessness and sweating were favorable prognostic factors. Excessive salivation, snout reflex, corneomandibular reflex, retractory nystagmus and stereotypic movements were unfavorable. The 8 patients who remained dysarthric showed marked diminution of their expiratory and inspiratory reserves, and of their forced vital capacity.

Adult↗
PubMedDate not supplied

Severe behavioural disturbance in families of patients with prolonged coma.

This paper describes the psychological dynamics among family members of patients with prolonged coma. We discuss the conflicts these families meet and how they affect their interpersonal relationships. Special focus is placed on overt and covert aggression towards the attending staff, an issue that has not received much attention. The unconscious motives underlying these overt aggressive behaviours are described, with an emphasis on how projective mechanisms come into play. We suggest a partial solution to be implemented in units treating these kinds of patients.

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↗
PubMedDate not supplied

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↗
PubMedDate not supplied

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↗
PubMedDate not supplied

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↗
PubMedDate not supplied

Some aspects of the humoral and neutrophil functions in post-comatose nawareness patients.

Post-comatose unawareness (PCU) is one of the possible outcomes of severe brain injury. Patients with severe brain injury have an increased susceptibility to severe nosocomial infections for multifactorial reasons, including immune suppression at different levels. We studied different immunological aspects in 11 PCU patients. Impaired humoral immunity was found in 27% of them. Two patients had decreased haemolytic activity of the classical complement pathway, associated with decreased levels of the components C1q, C1r and C4. Another patient had very low levels of IgG2 and IgG4. The neutrophil killing activity was impaired in these three patients, but was completely restored with the addition of a heterologous serum, suggesting a humoral defect. Neutrophils showed normal chemotaxis and random migration, and the superoxide anion release by neutrophils was also found to be normal. Understanding the immunological events in PCU patients contributes to a better and more intensive therapeutic approach, which might accelerate the rehabilitation of these patients.

Adolescent↗