Search PubMed⌕ Search

Biomedical subjects

R K Mulhern

Publications and source records attributed to R K Mulhern.

82 records · Page 5Linked to original sources
PubMed1985

Neuropsychologic function in children with brain tumors: III. Interval changes in the six months following treatment.

Twenty-six children with primary brain tumors were studied prospectively with regard to their sensorimotor, intellectual, academic, and emotional status. Serial evaluations were conducted after surgery (pre-irradiation) and six months after the completion of radiation therapy. The timing of the second evaluation was chosen so as to antedate the late effects of irradiation. Children over 6 years old displayed significant improvement of intellectual function over time, with only 11% exhibiting deterioration on one or more cognitive parameters. In contrast, 68% of younger children clinically deteriorated in one or more areas of intellectual functioning, with prominent difficulties in memory and selective attention for age. Children under 6 years old with supratentorial tumors were less likely than those with posterior fossa tumors to improve their cognitive performance. At the second evaluation, 23% of the patients were functioning below normal (IQ less than 80) intellectually, with 50% of the younger children and 11% of the older children receiving special educational assistance. Approximately 40-50% of the patients manifested emotional adjustment problems at each evaluation. The results are discussed in terms of the clinical need to follow similar patient populations with formal psychological assessments over time, and in terms of the difficulties involved in defining factors that determine the functional status of children surviving brain tumors.

Achievement↗
PubMed1984

Treatment of meningeal relapse in childhood acute lymphoblastic leukemia. I. Results of craniospinal irradiation.

Fourteen children were treated for isolated meningeal relapse occurring seven to 44 months (median, 14 months) after prophylactic cranial irradiation (2,400 rad/12 fractions) and intrathecal methotrexate (IT MTX, 12 mg/m2 for four doses during cranial irradiation). Eight had "high-risk" acute lymphocytic leukemia with age less than 2 years, white blood cell counts greater than 20,000, or T cell markers. Treatment for central nervous system leukemia included IT MTX (12 mg/m2 twice weekly until clearance of spinal fluid cytology) followed by craniospinal irradiation (CSI, 3,000 rad/20 fractions to the cranium and 1,800 rad/12 fractions to the spine). No maintenance IT MTX was given. Systemic chemotherapy was continued or reinstituted for a minimum of one year after CSI. No instance of second meningeal relapse has occurred. Five patients remain in secondary complete remission 66+, 54+, 36+, 26+, and 24+ months after meningeal relapse. Disease-free survival was limited by marrow relapse in eight patients (2-20 months after CSI) and testicular relapse in one. No acute toxicities were noted with CSI. Myelosuppression occurred in seven patients. Infections within two months of CSI were noted in five. No neurologic sequelae are apparent. Serial neuropsychometric studies in 10 patients revealed a significant decline in mean values on Global IQ scales. Long-term survival with acceptable toxicity is possible following aggressive, prompt treatment of meningeal relapse occurring after prophylactic cranial irradiation. Hematologic relapse remains the major obstacle to long-term disease-free survival.

Acute Disease↗
PubMed1983

Quality of life in children treated for brain tumors. Intellectual, emotional, and academic function.

Thirty children with primary brain tumors were evaluated for alterations in intellectual, emotional, and academic functions. Nine were studied following surgery (prior to irradiation) and 21 after postoperative irradiation. Twenty-four patients (80%) showed no serious disabilities on routine medical and neurological examinations. Nineteen patients (63%) had normal intelligence quotient (IQ) levels. Qualitative disabilities on routine examinations were observed in six children: two of nine tested postoperatively, one of six tested after posterior fossa irradiation, and three of 15 tested after cranial irradiation. Subnormal IQ levels were also noted in two of nine children tested prior to irradiation and one of six after posterior fossa irradiation. Of the 15 studied after cranial irradiation, eight had subnormal IQ scores. Serial postirradiation testing in 10 patients revealed improvement in two, stability in five, and further deterioration in three. Ten children were placed in learning disability settings due to achievement delays or problems with selective attending. Social-emotional evaluations detected excessive tendencies toward psychotic symptomatology. Potential etiological factors, including primary tumor site, extent of irradiation, age, and increased intracranial pressure, are discussed. Preliminary findings suggest a greater than normal risk for late neuropsychological alterations among children with supratentorial tumors and/or cranial irradiation.

Achievement↗
PubMed1983

Neuropsychologic function in children with brain tumors: II. Serial studies of intellect and time after treatment.

Serial neuropsychologic studies were performed in 18 children following surgery and irradiation for brain tumors. Initial evaluations (#1) 3-70 months post therapy (median 22 months) revealed subnormal full scale IQ (FSIQ less than 90) in nine. Time elapsed since treatment did not significantly correlate with IQ or memory scores. Second evaluations (#2) 10-23 months after #1 showed FSIQ stability in 12 (67%) and improvement (FSIQ greater than or equal to 10 points higher) in three. Deterioration (FSIQ greater than or equal to 10 points lower) was noted in three, in each case associated with clinically significant neurologic events. Serial memory scores improved in two, remained stable in 10, and declined in six. Third evaluations (#3), 6-23 months after #2, documented FSIQ stability in 8/9 studied and significant, late improvement in one. The effect of age is suggested primarily in memory-oriented functions. Selective attending is abnormal at #1 in 6/9 less than 6 years old at diagnosis, and 1/9 greater than or equal to 6 years. Interval decline in memory scores between #1 and #2 occurred in 5/9 less than 6 years old at diagnosis, and 1/9 greater than or equal to 6 years. The findings support earlier observations of relative declines in intellectual function in this population. Identification of intellectual delays requiring special educational assistance permits learning intervention early in the child's course. Substantial interval improvement apparent in 4/18 children indicates some degree of repair or adaptation with time, likely affected by directed educational programs.

Adolescent↗
PubMed1983

Death of a child at home or in the hospital: subsequent psychological adjustment of the family.

Twenty-four families who had participated in a Home Care Program for children terminally ill with cancer and 13 families of similar children who had died in the hospital completed inventories on parent and sibling personality as well as family functioning three to 29 months after the child's death. Parents of patients who received terminal care in the hospital were more anxious, depressed, and defensive and had greater tendencies toward somatic and interpersonal problems than parents of patients in the Home Care Program. Siblings of patients who received terminal care in the hospital were more emotionally inhibited, withdrawn, and fearful than their counterparts in the Home Care Program. Although some group differences in parental personality may have antedated terminal care, these results confirm parental reports of more adequate family adjustment following participation in a structured Home Care Program.

Adaptation, Psychological↗
PubMed1983

A comparison study of parental adaptation following a child's death at home or in the hospital.

Mothers and fathers of 37 deceased pediatric oncology patients were interviewed 3 to 28 months after their child's death. Twenty-four of these families had participated in a formal Home Care Program for dying children, whereas the remaining 13 families had children who died in the hospital. Parental adaptation following the home care experience appeared to be more favorable than following terminal care and death in the hospital. Specifically, the parents who had cared for their terminally ill child at home displayed more positive adjustment patterns as indexed by their perception of how the child's death had affected their marriage, social reorientation, religious beliefs, and views on the meaning of life and death. Ratings given by parents providing home care indicated a significant reduction in guilt during the home care experience which was maintained at 6 and 12 months following the child's death. In contrast, parents who did not provide home care reported intensified feelings of guilt during their child's terminal hospitalization which were unresolved at one year after the child's death. The results are discussed in terms of the practical and emotional benefits that may be derived from a family's voluntary choice of home care for dying children.

Adaptation, Psychological↗
PubMedDate not supplied

Quantitative MRI of the brain in children with sickle cell disease reveals abnormalities unseen by conventional MRI.

Conventional MRI (cMRI) has shown that brain abnormalities without clinical stroke can manifest in patients with sickle cell disease (SCD). We used quantitative MRI (qMRI) and psychometric testing to determine whether brain abnormalities can also be present in patients with SCD who appear normal on cMRI. Patients 4 years of age and older with no clinical evidence of stroke were stratified by cMRI as normal (n = 17) or abnormal (n = 13). Spin-lattice relaxation time (T1) of gray and white matter structures was measured by the precise and accurate inversion recovery (PAIR) qMRI method. Patient cognitive ability was assessed with a standard psychometric instrument (WISC-III or WISC-R). In all 30 patients with SCD, qMRI T1 was lower than in 24 age- and race-matched controls, in cortical gray matter (P < .0006) and caudate (P < .0009), as well as in the ratio of gray-to-white matter T1 (P < .008). In the 17 patients who were shown to be normal by cMRI, qMRI T1 was still lower than in controls, in both cortical gray matter (P < .02) and caudate (P < .004). Histograms of voxel T1 show that the proportion of voxels with T1 values intermediate between gray and white matter (ie, consistent with encephalomalacia) was 9% higher than controls in patients shown to be normal by cMRI (P < .05) and 15% higher than controls in patients shown to be abnormal by cMRI (P < .0005). The full scale intelligence quotient (FSIQ) of all patients with SCD was 75, compared to the FSIQ of 88 in a historical control group of patient siblings (P < .001). The FSIQ of patients shown to be normal by cMRI was 79, significantly lower than the FSIQ of patient siblings (P < .04). The FSIQ of 71 in patients shown to be abnormal by cMRI was significantly lower than both the patient siblings (P < .005) and the patients shown to be normal by cMRI (P < .04). Patients shown to be abnormal by cMRI scored lower than patients shown to be normal by cMRI, specifically on the subtests of vocabulary (P = .003) and information (P = .03). Cognitive impairment is thus significant, even in patients with SCD who were shown to be normal by cMRI, suggesting that cMRI may be insensitive to subtle neurologic damage that can be detected by qMRI. Because cognitive impairment can occur in children normal by cMRI, our findings imply that prophylactic therapy may be needed earlier in the course of SCD to mitigate neurologic damage.

Adolescent↗