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Cerebral arteriovenous malformation in a neonate: Treatment by embolisation
INTERNATIONAL ABSTRACTS minimum of 8 months. In 11 patients operated on, ovarian torsion was found, and all 11 had ovarian enlargement seen preoperatively by sonography. The overall positive predictive value of the test was found to be 87.5%, and the specificity was 93.3%. Also, three periappendiceal abcesses were diagnosed by sonogram.--Thomas 1/. Whalen MUSCULOSKELETAL SYSTEM Tibial Fractures in Head-Injured Children. D. Wood and M.M.
Hoffer. J Trauma 27:65-68, (January), 1987. This retrospective review examines the outcome of 29 tibial fractures in 28 children aged 3 to 16 years (mean, 10.3 years) with associated head injuries. Twenty-one patients were injured when struck by an automobile, and 21 patients sustained other major injuries. Other fractures included femoral (9), pelvic (5), and skull (9). Tibial fracture locations included midshaft (21, 8 open), ankle (2), tibial plateau (2), distal third (2) , and proximal shaft (2). Healing time was prolonged in all groups and was felt to be related to immobility caused by neurologic sequelae of the head injury. Seventeen patients had attained independent ambulation and self-care. Four were partially dependent and seven totally dependent. The critical factor in level of function was the head injury.--Randall HI. Powell The Fate of the Nonoperated Hip and Cerebral Palsy. C. Carr and
J.R. Gage. J Pediatr Orthop 7:262-267, (May/June), 1987. Thirty-six patients with cerebral palsy who had undergone a unilateral surgical procedure for spastic hip subluxation or dislocation were retrospectively reviewed. Fourteen had soft tissue surgery unilaterally, 14 had bony surgery, and eight had combined bony and soft tissue surgery. Children operated on before age 9, with unilateral soft tissue surgery, had significant worsening of femoral head coverage on the nonoperated side in 13% of the group. Unilateral bony procedures had fewer contralateral problems. Prognosis was also found to be worse if the patient's neurologic loss restricted the ability to ambulate. If the unilateral surgery failed, the risks to the contralateral side disappeared. The essence of the article is that unilateral hip surgery in patients with cerebral palsy is a procedure with significant risks to the contralateral side.~Anthony H. Alter Hip Dislocation in Spastic Cerebral Palsy: Long-term Consequences. D.R. Cooperman, E. Bartucci, E. Dietricke, et al. J
Pediatr Orthop 7:268-276, (May/June), 1987. This is a retrospective study of 38 noninstitutionalized patients with spastic quadriplegia, including 51 hip dislocations. Follow-up was 18 years, and the average patient age was 26 years. Eighteen unreduced unilateral hip dislocations were found to have pelvic obliquity and scoliosis in 12 patients. Reduction of the hip in seven unilateral cases showed only two of these patients to have pelvic obliquity and scoliosis. Half of the residual dislocated hips were painful. Surgery for pain relief required resection distal to the lesser trochanter to effect the desired goal. In bilateral hip dislocations, the authors suggest bilateral efforts at reductions, but in patients with a level pelvis, no treatment is indicated.--Anthony H. Alter Heyman-Herndon Tarsal-Metatarsal Capsulotomy for Metatarsus Adductus. Results in 48 Feet. J.G. Stark, J.E. Johanson, and R.B.
143 between 5 and 6 years of age, and the average follow-up was 9 years. Operating at a younger age did not improve the results. At follow-up, twenty-two feet were found to have degenerative changes, four of which were moderate to severe. The authors conclude that the procedure probably has little value. There were no cases that were over-corrected, which raises the question as to whether the procedure dealt with the true pathology of the lesion. Interest to date has focused on the appearance of the foot. The authors have shown that postoperative pain in long-term follow-up is a problem of much greater significance.--Anthony H. Alter NERVOUS SYSTEM Cerebral Arteriovenous Malformation in a Neonate: Treatment by Embolisation. F. McCord, M. Shields, A. McNeil, et al. Arch Dis
Child 62:1273-1275, (December), 1987. A full-term infant is described with congestive cardiac failure at the age of three days due to an aneurysm of the great vein of Galen diagnosed through cerebral ultrasound, Doppler studies, aortic arch angiography, and CT scanning. The aneurysm was embolized via an occipital burr hold and the straight sinus using helical stainless steel coils with thrombogenic Dacron wool filaments. Twenty-four coils were inserted in two procedures performed when the infant was 18 days and 5 weeks of age. Postoperatively, the congestive cardiac failure ceased, and 2 Doppler ultrasound examinations showed no aneurysmal flow. Development at the age of 21 months was normal. The authors comment on the extremely poor outcome in infants with this condition treated by other methods.--D.M. Burge NEOPLASMS Surgical Aspects of N-myc Oncogene Amplification of Neuroblastoma. A. Nakagawara, K. Ikeda, T. Yokoyama, e/ al. Surgery
104:34-40, (July), 1988. The surgical aspects of N-myc oncogene amplification of neuroblastoma were studied in 42 patients. Where there were 10 copies (H group) was 0% by 20 months (P < .000001). Clinical factors of prognosis (age, stage, histology, primary site) correlated with the N-myc amplification. Amplification was more frequent in patients with neuroblastoma than with ganglioneuroblastoma, and it occurred only in tumors in the suprarenal region. In the advanced stage, total or nontotal resection did not affect survival in the L group. Survival interval was prolonged significantly by total tumor removal in the H group.--John N. Schullinger Limb Salvage in Sarcomas in Children. J.W. van der Eijken. World
J Surg 12:318-325, (June), 1988. This article is one in a symposium dealing with soft tissue sarcoma. Various reconstruction techniques are reviewed that emphasize the technical problems one must surmout in the child when one or more epiphyses are sacrificed. The results with 131 patients are reviewed. Seventy of the children underwent operative therapy. Forty of them are alive with no evidence of disease, two are alive with disease, 25 have died, and two were lost to follow-up. Analysis of the series by tumor type is presented in tabular fashion.--Thomas 1I. Whalen
Winter. J Pediatr Orthop 7:305-310, (May/June), 1987. Fifty-six feet in 37 patients had failed conservative care in metatarsus adductus, and were operated on with a HeymanHerndon procedure. Five patients (eight feet) were not available for follow-up. Seventeen patients (26 feet) were evaluated (22 boys and ten girls). The total series showed that 22 feet had good results, seven fair, and 19 poor. This included a 50% incidence of pain in late follow-up. The mean age at the time of surgery was generally
Surgical Management of Thoracic Malignancy in Childhood: 8 Years" Experience in Leeds. J.P.A. Lodge, J.R.L. Hamilton, D.R.
Walker, et al. Ann R Coil Surg Engl 70:109-112, (March), 1988. Over an 8-year period, 13 children with thoracic malignancy were reviewed. Three of five with neuroblastoma are alive, but one has metastases. Two of eight children with pulmonary metastases are alive 2 and 6 years after resection.--B.A. Madarikan
Hoffer. J Trauma 27:65-68, (January), 1987. This retrospective review examines the outcome of 29 tibial fractures in 28 children aged 3 to 16 years (mean, 10.3 years) with associated head injuries. Twenty-one patients were injured when struck by an automobile, and 21 patients sustained other major injuries. Other fractures included femoral (9), pelvic (5), and skull (9). Tibial fracture locations included midshaft (21, 8 open), ankle (2), tibial plateau (2), distal third (2) , and proximal shaft (2). Healing time was prolonged in all groups and was felt to be related to immobility caused by neurologic sequelae of the head injury. Seventeen patients had attained independent ambulation and self-care. Four were partially dependent and seven totally dependent. The critical factor in level of function was the head injury.--Randall HI. Powell The Fate of the Nonoperated Hip and Cerebral Palsy. C. Carr and
J.R. Gage. J Pediatr Orthop 7:262-267, (May/June), 1987. Thirty-six patients with cerebral palsy who had undergone a unilateral surgical procedure for spastic hip subluxation or dislocation were retrospectively reviewed. Fourteen had soft tissue surgery unilaterally, 14 had bony surgery, and eight had combined bony and soft tissue surgery. Children operated on before age 9, with unilateral soft tissue surgery, had significant worsening of femoral head coverage on the nonoperated side in 13% of the group. Unilateral bony procedures had fewer contralateral problems. Prognosis was also found to be worse if the patient's neurologic loss restricted the ability to ambulate. If the unilateral surgery failed, the risks to the contralateral side disappeared. The essence of the article is that unilateral hip surgery in patients with cerebral palsy is a procedure with significant risks to the contralateral side.~Anthony H. Alter Hip Dislocation in Spastic Cerebral Palsy: Long-term Consequences. D.R. Cooperman, E. Bartucci, E. Dietricke, et al. J
Pediatr Orthop 7:268-276, (May/June), 1987. This is a retrospective study of 38 noninstitutionalized patients with spastic quadriplegia, including 51 hip dislocations. Follow-up was 18 years, and the average patient age was 26 years. Eighteen unreduced unilateral hip dislocations were found to have pelvic obliquity and scoliosis in 12 patients. Reduction of the hip in seven unilateral cases showed only two of these patients to have pelvic obliquity and scoliosis. Half of the residual dislocated hips were painful. Surgery for pain relief required resection distal to the lesser trochanter to effect the desired goal. In bilateral hip dislocations, the authors suggest bilateral efforts at reductions, but in patients with a level pelvis, no treatment is indicated.--Anthony H. Alter Heyman-Herndon Tarsal-Metatarsal Capsulotomy for Metatarsus Adductus. Results in 48 Feet. J.G. Stark, J.E. Johanson, and R.B.
143 between 5 and 6 years of age, and the average follow-up was 9 years. Operating at a younger age did not improve the results. At follow-up, twenty-two feet were found to have degenerative changes, four of which were moderate to severe. The authors conclude that the procedure probably has little value. There were no cases that were over-corrected, which raises the question as to whether the procedure dealt with the true pathology of the lesion. Interest to date has focused on the appearance of the foot. The authors have shown that postoperative pain in long-term follow-up is a problem of much greater significance.--Anthony H. Alter NERVOUS SYSTEM Cerebral Arteriovenous Malformation in a Neonate: Treatment by Embolisation. F. McCord, M. Shields, A. McNeil, et al. Arch Dis
Child 62:1273-1275, (December), 1987. A full-term infant is described with congestive cardiac failure at the age of three days due to an aneurysm of the great vein of Galen diagnosed through cerebral ultrasound, Doppler studies, aortic arch angiography, and CT scanning. The aneurysm was embolized via an occipital burr hold and the straight sinus using helical stainless steel coils with thrombogenic Dacron wool filaments. Twenty-four coils were inserted in two procedures performed when the infant was 18 days and 5 weeks of age. Postoperatively, the congestive cardiac failure ceased, and 2 Doppler ultrasound examinations showed no aneurysmal flow. Development at the age of 21 months was normal. The authors comment on the extremely poor outcome in infants with this condition treated by other methods.--D.M. Burge NEOPLASMS Surgical Aspects of N-myc Oncogene Amplification of Neuroblastoma. A. Nakagawara, K. Ikeda, T. Yokoyama, e/ al. Surgery
104:34-40, (July), 1988. The surgical aspects of N-myc oncogene amplification of neuroblastoma were studied in 42 patients. Where there were
J Surg 12:318-325, (June), 1988. This article is one in a symposium dealing with soft tissue sarcoma. Various reconstruction techniques are reviewed that emphasize the technical problems one must surmout in the child when one or more epiphyses are sacrificed. The results with 131 patients are reviewed. Seventy of the children underwent operative therapy. Forty of them are alive with no evidence of disease, two are alive with disease, 25 have died, and two were lost to follow-up. Analysis of the series by tumor type is presented in tabular fashion.--Thomas 1I. Whalen
Winter. J Pediatr Orthop 7:305-310, (May/June), 1987. Fifty-six feet in 37 patients had failed conservative care in metatarsus adductus, and were operated on with a HeymanHerndon procedure. Five patients (eight feet) were not available for follow-up. Seventeen patients (26 feet) were evaluated (22 boys and ten girls). The total series showed that 22 feet had good results, seven fair, and 19 poor. This included a 50% incidence of pain in late follow-up. The mean age at the time of surgery was generally
Surgical Management of Thoracic Malignancy in Childhood: 8 Years" Experience in Leeds. J.P.A. Lodge, J.R.L. Hamilton, D.R.
Walker, et al. Ann R Coil Surg Engl 70:109-112, (March), 1988. Over an 8-year period, 13 children with thoracic malignancy were reviewed. Three of five with neuroblastoma are alive, but one has metastases. Two of eight children with pulmonary metastases are alive 2 and 6 years after resection.--B.A. Madarikan