Large Congenital Hydrocephalus:Extended Survival without Neurosurgery.

Professional Presentation: This work was presented at the 57th Quarterly Grand Rounds at Fairview Developmental Center, Costa Mesa, California on October 17, 2012.

Acknowledgment: Authors are grateful to Stephan Reynolds CRT, and Indira Makwana for records.

Conflict Of Interest: None of the authors has any conflict of interest with the information provided in this article.

Human bites: bloodborne pathogen risk and postexposure follow-up algorithm.

Human bites may transmit bloodborne pathogens (BPs) by exposing the biter's oral mucosa to the bitee's blood and the bite wound to biter's saliva. Consequently, bites may require postexposure follow-up per the Occupational Safety and Health Administration (OSHA) BP standard. Literature reveals that BP transmission via bites is rare.

Necrotizing fasciitis: diagnostic challenges in a mute bedridden patient with atypical laboratory parameters.

A 27-year-old mute bedridden patient required parenteral corticosteroids and antibiotics, and hospitalization for an acute respiratory illness. After 2 days, staff noted a ~0.3 cm blister on the patient's right heel.

Piperacillin-induced immune hemolysis presenting with tachycardia and cardiac arrest.

A 20-year-old nonverbal patient with profound developmental disabilities was treated with intravenous piperacillin-tazobactam for respiratory infection. After 8 days, he became afebrile with normal pulmonary status, but his pulse remained inexplicably rapid (114/minute). Investigations revealed severe normochromic normocytic hemolytic anemia (hemoglobin: 40 g/L, reticulocytes: 9.

Serious pH1N1 influenza illness and pneumonia despite inactivated vaccine: success of prompt diagnosis and treatment.

A 42-year-old bedridden patient suddenly became seriously ill with an unexplained fever (39 degrees C) and hypoxemia (pulse oximetry oxygen saturation: patient, 90%; normal, >98%). He had received the inactivated vaccine for pandemic 2009 H1N1-influenza (pH1N1) 41 days earlier. He had no cough, sore throat, or pharyngitis.

Intermittent diarrhea as a delayed presentation of percutaneous endoscopic gastrostomy (PEG)-associated fistula.

A 60-year-old patient with severe dysphagia, weight loss, and recurrent aspiration pneumonia required a percutaneous endoscopic gastrostomy (PEG) for long-term feeding. After 24 uneventful days, she developed an enigmatic recurring but intermittent diarrhea. On day 62, staff noted a feculent odor from her gastrostoma, along with undigested formula in her stools.

The wheelchair thrombosis syndrome.

Objective: To report a case of deep vein thrombosis (DVT) related to prolonged wheelchair use.

Case Report: A 48-year-old patient with spastic quadriplegia usually spent 10-12 hours daily in a wheelchair. He suddenly developed marked swelling of his right foot, leg and thigh.

Deep vein thrombosis in a tetraparesic patient with mental retardation: case report and review of the literature.

Objective: To report a case of deep vein thrombosis (DVT) in a tetraparesic patient, a member of a population in which DVT is reportedly rare.

Case Report: A 36-year old tetraparesic resident of a developmental centre suddenly developed swelling of one leg. Her plasma D-dimer level was 751 (normal<500) ng ml-1.

Esophageal obstruction by a lemon that required esophagotomy: thoughts on prevention.

A patient with pica and Lennox Gastaut syndrome suddenly refused oral intake. Neck radiographs revealed no foreign body. Barium swallow identified an irregular filling defect in the cervical esophagus.

Identification of low bone mass in a developmental center: finger bone mineral density measurement in 562 residents.

Objectives: The objective of this study was to measure finger bone mineral density (BMD) in residents of a developmental center.

Design: A cross-sectional descriptive study performed during the residents' annual physical examination.

Setting: This study was conducted at a long-term care facility for people with severe developmental disabilities (mental retardation, cerebral palsy, epilepsy, and autism).

Sequential analysis reveals a unique structure for self-injurious behavior.

Conditional probability, calculated using sequential analysis techniques in four time conditions (2, 10, 30, and 60 seconds), provided evidence that successive episodes of self-injury were sequentially dependent. This unique distribution of sequential association for self-injurious behavior (SIB) was not related to frequency or rate of occurrence. Compared with other environmental and behavioral events, the best predictor of SIB was an earlier SIB episode, consistent with a contagious distribution.

End-of-life care for a man with developmental disabilities.

Background: Science can artificially maintain many essential life functions. Does such care prolong life or dying?

Methods: A case is described of a patient with developmental disability with unknown health care choices who was hospitalized for drug-resistant urosepsis. He developed aspiration pneumonia, deep vein thrombosis, and respiratory arrest.

Bloodborne pathogen exposures in a developmental center: 1993-2000.

In a developmental center, 257 potential bloodborne pathogen exposures (119 bites, 91 scratches, 30 sharps injuries, 17 mucosal breaks) occurred during 8 years (13,187 employee-years and 6,980 resident-years). Of the residents, 9% were hepatitis B virus (HBV) surface antigen carriers. Serological follow-up of exposed, susceptible employees and residents identified no transmission of HBV, hepatitis C virus (HCV), or human immunodeficiency (HIV) virus.

Epidemiology and control of enterobiasis in a developmental center.

Objective: To determine if enterobiasis could be controlled in a developmental center.

Design: Population-based study. Annual screening of all residents by perianal swabs for enterobiasis and on admission or discharge.

Fracture epidemiology and control in a developmental center.

During 3.5 years, 182 fractures occurred among 994 residents of a developmental center. The fracture rate was 5.

Parvovirus B19-antibody serosurvey in 500 developmentally disabled subjects.

Sera of 500 residents were screened for parvovirus B19 immunoglobulin M (IgM) and immunoglobulin G (IgG) by enzyme-linked immunosorbent assay. Positive IgM and equivocal IgG or IgM results were confirmed by immunofluorescent antibody and Western blot. IgM was detected in 13 sera (2.

Lead exposure of people with developmental disabilities: success of control measures.

In a developmental center, blood lead level was determined by atomic absorption for individuals who were admitted, discharged, or had pica. In 1977, blood lead level was 0 to 29 ug/dL in 298 (92%), 30 to 49 ug/dL in 20 (6%), and 50 to 79 ug/dL in 5 (2%) of the 323 individuals screened. In contrast, in 1994, blood lead level was 0 to 4 ug/dL in 58 (88%) and 5 to 9 ug/dL in 8 (12%) of 66 individuals screened.

Parvovirus B19 outbreak in a developmental center.

Of 49 employees serving developmentally disabled persons, 13 (27%) were found to have parvovirus B19 infection on the basis of serum positivity for parvovirus B19 IgM by enzyme-linked immunosorbent assay. Two employees had severe peripheral symmetric polyarthropathy lasting longer than 6 months. Infection control measures are described.

Self-injurious behavior within the menstrual cycle of women with mental retardation.

There are no reports of an association between the menstrual cycle and self-injurious behavior (SIB) in the mentally retarded population. However, the endogenous opiate system has been implicated in both menstrual cycling and SIB. Catamenial and behavioral records of 9 women with mental retardation who exhibited SIB were analyzed for 6 months to determine the association between phases of the menstrual cycle and rates of SIB.

Memory deficits associated with chronic fatigue immune dysfunction syndrome.

Performance on tests of memory in 39 patients who met Center for Disease Control (CDC) criteria for chronic fatigue immune dysfunction syndrome (CFIDS) was compared with 23 depressed patients (DSM-III-R) and 129 healthy controls. Although the CFIDS patients had normal neuropsychological profiles, they significantly overestimated their ability (metamemory), performed significantly worse on tests of recall as context increased (e.g.