Severe Poliomyelitis Research Articles

Biographical truths and their clinical consequences: Understanding ‘embodied memories’ in a third psychoanalysis with a traumatized patient recovered from severe poliomyelitis

The relationship between ‘narrative’ and ‘historical–biographical truth’ in psychoanalytic treatment has become the subject of many controversial debates in recent years. Findings of contemporary memory research have lead to great scepticism as to whether therapists are able objectively and reliably to reconstruct biographical events on the basis of their observations in the therapeutic situation. Some authors even claim that psychoanalysts should concentrate exclusively on observing the here and now of the patient′s behaviour within the transference relationship to the analyst. In this paper it will be discussed whether the baby has been thrown out with the bathwater in this debate. Centred around the insights from a third psychoanalysis with a patient who suffered from a severe case of childhood polio, the hypothesis will be discussed that working through the traumatic experience in the transference with the analyst, as well as the reconstruction of the biographical–historical reality of the trauma suffered, prove to be indispensable for a lasting structural change.Integration of the trauma into one′s own personal history and identity is and remains one of the main aims of a psychoanalytic treatment with severely traumatized patients. The reconstruction of the original trauma is indispensable in helping the patient to understand the ‘language of the body’ and to connect it with visualizations, images and verbalizations. The irreversable wounds and vulnerability of his body as the ‘signs of his specific traumatic history’ have to be recognized, emotionally accepted and understood in order to live with them and not deny them any longer. Another important aspect in psychoanalysis is to develop the capability to mentalize, in other words, to understand the intentions of central (primary) objects related to the trauma.The concept of ‘embodied memory’ might be helpful in understanding precisely in what way ‘early trauma is remembered by the body’. Observing in detail the sensory‐motor coordinations in the analytic relationship enables one to decode the inappropriate intensity of affects and fantasies which match the original traumatic interaction and are revealed as inappropriate reactions in the present, new relationship to the analyst.

Heparan sulfate-independent infection attenuates high-neurovirulence GDVII virus-induced encephalitis.

The high-neurovirulence Theiler's murine encephalomyelitis virus (TMEV) strain GDVII uses heparan sulfate (HS) as a coreceptor to enter target cells. We report here that GDVII virus adapted to growth in HS-deficient cells exhibited two amino acid substitutions (R3126L and N1051S) in the capsid and no longer used HS as a coreceptor. Infectious-virus yields in CHO cells were 25-fold higher for the adapted virus than for the parental GDVII virus, and the neurovirulence of the adapted virus in intracerebrally inoculated mice was substantially attenuated. The adapted virus showed altered cell tropism in the central nervous systems of mice, shifting from cerebral and brainstem neurons to spinal cord anterior horn cells; thus, severe poliomyelitis, but not acute encephalitis, was observed in infected mice. These data indicate that the use of HS as a coreceptor by GDVII virus facilitates cell entry and plays an important role in cell tropism and neurovirulence in vivo.

Dyspnea in a Patient Years After Severe Poliomyelitis

Dyspnea after polio can occur for a variety of reasons, including neuromuscular disease and upper airway abnormalities resulting from prolonged intubation, including tracheal stenosis, tracheomalacia, and vocal cord paralysis. Routine studies such as spirometry and maximum voluntary ventilation (MVV) measurements can give similar results in these conditions. We present a 50-year-old woman who as a child developed poliomyelitis that required tracheostomy and negative pressure ventilation. Thirty-nine years later, she developed breathlessness with normal spirometry but decreased MVV. The flow volume loop showed flattening of the inspiratory and expiratory limbs, consistent with a fixed upper airway obstruction or neuromuscular weakness. Exercise testing with measurement of exercise flow volume loops and respiratory pressures was performed. The patient was ventilatory limited with increasing end-expiratory lung volume through exercise. Flow volume loops confirmed flow limitation. Respiratory pressures did not change after maximal exercise. Further evaluation confirmed left vocal cord paralysis and tracheomalacia. This patient demonstrates that the causes of dyspnea after poliomyelitis can be multifactorial, and that routine evaluation may fail to elucidate the limiting factor. In this case, exercise testing provided valuable insight into the limiting factor for this patient and provided useful data for counseling and for further management.

NEUROMUSCULAR FUNCTION IN POLIO SURVIVORS

Although there is no documented, objective evidence that symptomatic post-polio subjects are rapidly losing strength, they have a number of neuromuscular deficits related to a more severe poliomyelitis illness that may explain why they complain of problems with strength, endurance, and local muscle fatigue. Symptomatic post-polio subjects were hospitalized longer during the acute poliomyelitis, recovered more slowly, and had electromyographic evidence of greater loss of anterior horn cells. Additionally, recent assessment demonstrated that they were weaker, had a reduced work capacity, and recovered strength less readily after activity in the quadriceps muscles as compared to asymptomatic subjects. Of great clinical importance, rating of perceived exertion in the muscle during exercise was the same in symptomatic and asymptomatic post-polio and control subjects, indicating that symptomatic subjects have a mechanism to monitor local muscle fatigue that could be used to avoid exhaustion. A study of pacing (interspersing activity with rest breaks) showed that symptomatic subjects had less local muscle fatigue and greater strength recovery when they paced their activity than when they worked at a constant rate to exhaustion. We recommend that post-polio individuals pace their daily activity to avoid excessive fatigue.

Rotation osteotomy of the tibia after poliomyelitis. A review of 51 patients

After severe poliomyelitis, which is still relatively common in some developing countries, lateral rotation deformity of the tibia may occur. We have reviewed 51 patients treated by O'Donoghue's rotation osteotomy of the tibia. An average lateral rotation deformity of 57 degrees was fully corrected in all the patients, and in 38 of them the graft obtained during the osteotomy was used for a simultaneous Grice-Green subtalar arthrodesis in one or both feet. All the osteotomies united in an average of 11 weeks, some with relatively minor and unintentional posterior angulation. There was no posterior angulation when the length of the step cut osteotomy was 4.5 cm or more. O'Donoghue's osteotomy is a simple and safe operation, being particularly advantageous if a Grice-Green procedure is also required.

Onuf's motoneuron is resistant to poliovirus

Onuf's nucleus, located in the anterior horn of the sacral spinal cord, has been shown to innervate the striated muscles of the urethral and anal sphincters and is known to be well preserved in patients who have motoneuron disease. To answer the question whether the nucleus is also safe from motoneurotrophic virus infections, we examined the spinal cords of 3 individuals who had suffered severe poliomyelitis. In 2 of these which were acutely fatal cases, all motoneurons were damaged by neuronophagia, but Onuf's nucleus escaped the inflammatory degeneration. In a chronic case, neuronal loss in the anterior horn with replacement by gliosis was prominent below the thoracic cord down to the sacral cord, but Onuf's nucleus was well preserved. Thus, Onuf's nucleus appears to differ from other motoneurons with regard to susceptibility to poliovirus infection.

The development of apparatus for intermittent negative pressure respiration (2) 1919–1976, with special reference to the development and uses of cuirass respirators

This paper and the one that preceded it1 have traced the development of the design and use of negative pressure ventilators from their origins in the early nineteenth century to the present day. Their maximum use was in the nineteen-forties and the early fifties after which they were quite rapidly replaced in the treatment of acute respiratory disease by intermittent positive pressure ventilators-the turning point being the severe poliomyelitis epidemic in Copenhagen in 1952. Negative pressure ventilators, particularly cuirass ventilators, still have a place in the treatment of chronic respiratory disease.

A new factor in urolithiasis: long-term effects of severe respiratory poliomyelitis.

Summary 25 (41%) patients, in a review of 61 patients with severe respiratory poliomyelitis, developed urolithiasis. There was a significantly increased incidence of stone formation in the urinary tract amongst those using the tank respirator when compared with those on intermittent positive pressure ventilation (I.P.P.V.). It is suggested that overventilation of patients on I.P.P.V. protects against urolithiasis by a direct action on calcium metabolism. No correlation existed between the occurrence of urolithiasis and either urinary tract infection or the degree of immobility.

Cartilage calcification and rib erosion in chronic respiratory poliomyelitis

Radiographs of 32 patients treated for severe poliomyelitis for variable periods in tank respirators have been studied. Two groups of lesions have been encountered. Rib erosions, forming the first group, are considered to be caused by pressure of the scapula. Calcification of intervertebral discs, narrowing of sacro-iliac joints, calcification of the acetabular labrum and sclerosis of lumbar apophyseal joints form the second group; these findings have not been reported before as a complication of poliomyelitis. The causation is discussed but the precise mechanism remains undetermined.

A SURVEY OF IMMUNIZATION LEVELS AFTER AN ORAL POLIOVACCINE PROGRAM IN CLEVELAND.

IN THE LATE spring and summer of 1962, an intensive program for distribution of Sabin oral poliovaccine was carried out in the Cleveland area. This program was modeled after the "Sabin-on-Sunday" (SOS) method of community immunization developed in Phoenix and Tucson, Arizona.¹As the campaign progressed, it appeared that community-wide participation had been achieved as evidenced by the crowds of people who came to distribution centers in all socioeconomic areas. Efforts to achieve this goal of community-wide immunization have been stimulated by the occurrence in recent years of severe poliomyelitis epidemics with concentration of high attack rates in the lower socioeconomic areas of cities 2S and the concurrent observation of generally low levels of inactivated poliovaccine immunization levels in the areas with highest rates.^5-8Although much work has been expended in campaigns to reduce this problem, results frequently have been less successful in reaching the target populations than was

Audiologic Findings in Seventy-Three Severe Poliomyelitis Patients

A study of the hearing acuity of 37 extensively paralyzed poliomyelitis patients assessed by pure tone and speech audiometry was reported in a preliminary study.¹Deviation from normal threshold of audibility was found for both air and bone conduction pure tones and for speech hearing, tested by spondaic words. Almost all audiograms for this group showed a mild depression of sensitivity for the lower and middle frequencies, rising to near normal at 4,000 and 8,000 cps on the chart. A review of the

Coping Behavior under extreme stress. Observations of patients with severe poliomyelitis

Coping Behavior under extreme stress. Observations of patients with severe poliomyelitis

Coping behavior under extreme stress; observations of patients with severe poliomyelitis.

Introduction The life-threatening impact of severe poliomyelitis has been vividly described both in the scientific literature and in popular reports about polio patients. Here, for instance is a patient's description of his experience in the acute phase of illness. The realization that I was paralyzed came to me with a merciful gradualness. As the extreme lassitude and weakness left by the fever and the pain wore off, the irritations took over. I yearned to change my position, to move ever so slightly onto a cooler spot on the sheet, and I couldn't. My heels itched and I couldn't even move them up and down on the bed. Three weeks ago there had been nothing to any of it—breathing, speaking, eating, evacuating, sleeping. I had accepted my body as if it were myself. If I wanted to eat, I ate—whatever and whenever I liked. If I wanted to

Effectiveness of Salk vaccine in reducing nonparalytic poliomyelitis in a large urban epidemic.

IN the 1954 field trial with poliomyelitis vaccine1 and in subsequent outbreaks of poliomyelitis2 3 4 5 6 the Salk vaccine was shown to be highly effective in reducing the incidence of paralytic poliomyelitis. Although it might be expected theoretically, evidence for a comparable effectiveness against nonparalytic poliomyelitis was not described. Kansas City, Missouri, had a severe poliomyelitis epidemic in 1959 that was carefully investigated. Etiologic studies were performed in four fifths of the cases. The majority of the reported paralytic and nonparalytic cases were proved to be due to poliovirus Type 1 infection. Other enterovirus infections were associated with the aseptic-meningitis syndrome in . . .

Thrombophlebitis in Patients with Severe Poliomyelitis

THIS report is presented to call attention to the occurrence of idiopathic thrombophlebitis in severely paralyzed patients and to point out that this may occur in other debilitating neuromuscular diseases. There have been references to fatal pulmonary embolism in patients with severe paralysis due to poliomyelitis.1 2 3 4 Furthermore, thrombophlebitis may be expected to occur in any adult patient who is immobilized for a long time. A survey of the patients admitted to the Mary MacArthur Memorial Respirator Unit from its inception in October, 1950, through January 31, 1958, was made to obtain an estimate of the frequency of this complication.The . . .

Medical and surgical complications associated with severe poliomyelitis

With newly acquired knowledge, advances in technology, more suitable medical equipment, and broader application of the multidisciplinary approach to total rehabilitation, the complications in severe acute illnesses and chronic disability can be controlled in a much better fashion than previously. The detection and treatment of these complications are usually the same whether they occur in patients with poliomyelitis or in patients with other diseases. It is important that we do not cast aside lessons learned in the management of severe poliomyelitis. We should apply these same methods and techniques to other chronic disabilities, which will certainly increase in number as physicians become more and more proficient in the management of acute illnesses.

A Study of the Hearing Level Following Severe Poliomyelitis

Disturbance of the special senses are rarely described as being associated with poliomyelitis. 1,2 This has been true in spite of demonstrable central nervous system lesions that would suggest such a possibility. As early as 1894 Redlich 3 stated that, of all the pontine structures, the lateral vestibular nucleus (Deiters') and the acoustic nucleus were the most severely damaged in bulbar poliomyelitis. Matzke and Baker, 4 in a report dealing exclusively with the effects of poliomyelitis on the pons, found this part of the brain to be involved in practically every one of the 109 cases of bulbar poliomyelitis examined pathologically. This damage consisted primarily of a diffuse interstitial-cell infiltration and neuronal damage. In approximately one-third of the cases there were moderate to severe inflammatory changes within the vestibular nuclei, and in five of these the changes had progressed to actual tissue necrosis. Other reports also deal with damage to

Cardiorespiratory problems in severe poliomyelitis observed during the recent epidemic.

DURING the 1955 epidemic in Massachusetts more than 400 patients with poliomyelitis were hospitalized at the Massachusetts General Hospital. There were 74 adults requiring respirator management, with 17 fatal cases. Death in acute poliomyelitis that is not the result of obvious airway obstruction, ventilatory insufficiency or some other specific complication has been attributed to circulatory collapse secondary to involvement of the medullary vasomotor center1 , 2 and, less frequently, to circulatory collapse from myocarditis.3 The observations reported below appear to amend these concepts and suggest other possibilities and empirical methods of management. Presentation of the Clinical Material An analysis of these 17 . . .

Etiology and treatment of urinary lithiasis in severe poliomyelitis.

A CURSORY search of the urological literature has revealed only one title in recent years referring to the occurrence of urinary lithiasis in poliomyelitis.1Boyd2mentioned it in a discussion of lithiasis in bedridden patients, and there are probably other such references, since the relationship appears to be a fairly frequent one. It may be that the prolonged survival of patients with severe poliomyelitis is of such recent development that there has not been sufficient time for the situation to attract much attention. It has long been known that diseases and disorders requiring prolonged immobilization in bed are frequently complicated by urinary lithiasis, particularly if there is extensive disease of bone (severe fractures, osteomyelitis) or paralysis. Factors which may lead to stone formation in such circumstances include (1) hypercalcinuria from disuse atrophy of the skeleton; (2) stasis in the dependent renal calices; (3) concentration of the urine from

Pulmonary function in convalescent poliomyelitic patients. I. Pulmonary subdivisions and maximum breathing capacity.

THE severe poliomyelitis epidemics of recent years and the increasing success of treatment during the acute stages of respiratory failure have emphasized the need for more knowledge of the changes in pulmonary function during recovery from respiratory-muscle involvement. Such information would be of value in estimating a patient's progress, in formulating prognosis, and in assessing the effects of therapeutic procedures and the need for respiratory appliances.The degree of respiratory impairment in the acute phase of poliomyelitis varies markedly from patient to patient, and in convalescence all degrees of recovery occur (as in other types of neuromuscular paralysis). In the . . .