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2 results

  • Case 9 - Woman with visual complaints

  • Edited by Serge Gauthier, McGill University, Montréal, Pedro Rosa-Neto, McGill University, Montréal
  • Book:
    Case Studies in Dementia
    Published online:
    16 May 2011
    Print publication:
    21 April 2011, pp 59-63

  • Summary

    This chapter conveys that a 65-year-old technical worker with previous management function had been unable to work because of pulmonary problems for 7 years. This highly educated man had been diagnosed with extrinsic allergic alveolitis 7 years ago. A diagnosis of subjective memory complaints (SMC) was made. The fact that cerebrospinal fluid (CSF) values were abnormal was not taken into account at that time because of lack of a clinical diagnosis of dementia. Referral to a psychiatrist was advised for evaluation of a possible mood disorder and for counseling on how to deal with his behavioral disturbances. SMC or subjective cognitive impairment (SCI) in the absence of mild cognitive impairment (MCI) or dementia is more and more accepted as a separate clinical entity. Depression, anxiety, disturbed sleep, fatigue, and loss of energy were responsible for a conversion from SCI to MCI, but subsequently reverted back to SCI after follow-up.

  • Thoracic sequels after thoracotomies in children with congenital cardiac disease

  • Serpil Bal, Huda Elshershari, Reyhan Çeliker, Alpay Çeliker
  • Journal:
    Cardiology in the Young / Volume 13 / Issue 3 / June 2003
    Published online by Cambridge University Press:
    24 May 2005, pp. 264-267

  • The standard surgical approach for closed heart procedures in small infants and children is to use a posterolateral thoracotomy incision, which results in the division of the latissimus dorsi and serratus anterior muscles. The aim of our study was to determine the frequency and type of musculoskeletal deformities in children undergoing surgery with this approach for congenital cardiac disease.

    We included 49 children, 28 boys and 21 girls, in the study. Their mean age was 10.2 ± 4.8 years, the mean age at the time of surgery was 3.8 ± 4.0 years, and they were evaluated at an average of 6 years after the thoracotomy. Of the patients, 94% had various musculoskeletal deformities. Scoliosis was observed in 15 patients (31%) but only in two patients did the curves exceed 25 degrees. Of these patients, three-fifths had aortic coarctation. Elevation of the shoulder was seen in 61%, winged scapula in 77%; while 14% had asymmetry of the thoracic wall due to the atrophy of the serratus anterior muscle. Deformity of the thoracic cage was observed in 18%; and 63% had asymmetry of the nipples.

    Thus, we found that musculoskeletal deformities are frequent after thoracotomies in children with congenital cardiac disease. Patients who have undergone such procedures for cardiac or noncardiac surgery should be followed until their skeletal maturation is complete. Techniques sparing the serratus anterior and latissimus dorsi muscles should be preferred. These adverse effects of thoracotomy may be another reason for using interventional procedures in these cases.