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Emergency intracranial pressure monitoring in pediatrics
INTERNATIONAL ABSTRACTS NERVOUS SYSTEM Surgery in Tuberculous Meningitis. B. J. Darmany. Prog
Pediatr Surg 15:181-185, 1982. In Bombay, tuberculosis accounts for 22.1% of deaths in children aged 2 to 5 years, and neurotuberculosis is the cause of between 1.9% and 4.4% of paediatric hospital admissions. Out of 132 children with tuberculous meningitis, 50 developed hydrocephalus. Children who failed to respond to medical treatment or who had a rise in intracranial pressure, had ventriculography and early shunting. A high percentage showed considerable improvement in their neurological status.--RCM Cook Emergency Intracranial Pressure Monitoring in Pediatrics.
T. Mayer and M. L. Walker. Clin Pediatr 21:391-396, (July), 1982. Fifty-six patients with evidence of severe neurologic compromise (Glasco Coma Scale of 7 or less or inability to utter words or follow commands) underwent subarachnoid or intraventricular intracranial-pressure monitoring at the Inter Mountain Trauma Intensive Care Unit of the Primary Children's Medical Center. Diagnoses were head trauma, Reye's Syndrome, and hypoxic encephalopathy due to near drowning. All patients were treated with endotracheal intubation, hyperventilation, and intravenous dexamethasone. After CT scanning, patients with mass lesions were taken directly to the operating room for decompression while the remaining patients underwent intracranial-pressure monitoring immediately with placement of the bolt or catheter in the emergency room or intensive care unit. All patients were treated with methicillin sodium and ampicillin for the duration of monitoring. Eighty percent of the patients had intraeranialpressure elevations requiring treatment. The overall complication rate of intracranial-pressure monitoring was 5.3%; no serious complications were noted. The overall mortality in this group of patients was 14% but patients with hypoxic encephalopathy had significantly higher mortality (33%) compared to patients with head trauma (12.5%) or Reye's Syndrome (10%). Early diagnosis and aggressive treatment in these patients, including the use of intracranial-pressure monitoring, resulted in acceptable recovery in over 85% of these patients.--Richard J. Andrassy
NEOPLASMA Surgical Experience with Retrogastric end Retropancreatic Pheochromocytomas. H. W. Scott, Jr., R. H. Dean, J. W.
Lea IV, et al. Surgery 92:853-865, (November), 1982. Seven patients with retrogastric or retropancreatic pheochromocytomas are reported. Each of these tumors arose between the aorta and the inferior vena tara. Among these patients, one was age 14 and had episodic hypertension. After thorough evaluation, including CT scan and aortography, a mass in the right-adrenal area was localized. At operation, a right-adrenal pheochromocytoma was removed. However, despite preoperative alpha and beta blockade, the patient remained hypertensive and subsequent inferior vena caval venous sampling suggested a tumor at the level of the second lumbar vertebra. Subtraction films made of the previous
527
aortogram revealed an extra-adrenal second pheochromocytoma at the level of L2 in the midline. A subsequent operation removed this tumor which was not palpable until the duodenum was Kocherized. Recovery was uneventful. This report details the difficulties in localizing preoperatively and intraoperatively, smaller tumors in these unusual locations. The authors' experience suggests that small midline pheochromocytomas in these sites may be readily missed by CT, aortography, or surgical search at laparotomy unless subtraction arteriograms are used and the Kocher maneuver is routinely employed.--Eugene S. Wiener Nervous System Specific Enolase INSE): A New Tumor Marker for Neuroblastoma. Y. lshiguro, T. /to, M. Nagaya,
et al. J Jap Soc Pediatr Surg 18:1303-1309, (December), 1982. The authors measured serum levels of nervous system specific enolase (NSE) in 20 healthy adults, 20 infants and children having no malignancy, and 13 patients with neuroblastoma or ganglioneuroblastoma. Measurements were carried out with a sensitive solid-phase sandwich-enzyme immunoassay system, using a monospecific antibody to the gamma subunit of rat NSE for solid-phase preparation and for enzyme-labeled antibody. Serum NSE levels were 2.87 _+ 1.18 ng/mL in normal adults and 5.76 • 2.42 ng/mL in infants and children with no malignancy. Serum NSE levels in patients with neuroblastoma or ganglioneuroblastoma ranged from 6.2 to 230 with a mean of 103.8 _+ 108.0 ng/mL. Serum NSE levels in patients with neuroblastoma or ganglioneuroblastoma were above 10 ng/mL in 10 of 13 patients. These results suggest that the serum NSE could be used as a valuable tumor marker for the screening and therapeutic monitoring of neuroblastoma.--H. Suzuki Hepatic Resection for Secondary Neoplasms. C. E. Morrow,
T. B. Grage, D. E. R. Sutherland, el al. Surgery 92:610-614, (October), 1982. Hepatic resection for metastatic disease was performed in 64 patients with a cumulative survival rate of 45% at 2 years and 34% at 5 years. Single metastatic liver lesions were found in 46 patients (72%) and multiple lesions were found in 18 patients (28%). Lesions were resected from both the left and right side of the liver in seven patients. The operative procedures included 37 wedge resections, 20 segmentectomies, 16 lobectomies, and 2 total hepatectomies in preparation for liver transplantation. The operative mortality rate was 30%. The four patients with Wilm's tumors demonstrated the best 2-year (80%) and 5-year (50%) survival. Thirty patients (47%) with synchronous resections of the primary tumor and the hepatic metastases had a 2- and 5-year survival rate of 29% and 26% whereas 34 patients (53%) with metachronous resections had survival rates of 64% and 30% (P < 0.05). Eighteen patients underwent resection of multiple hepatic lesions with a survival rate essentially no worse than that of patients with isolated metastases (31% versus 18% respectively). The extent of the hepatic resection was primarily dictated by location and number. More extensive resections were not associated with a higher long-term survival rate but did have a higher operative mortality. The authors concluded
Pediatr Surg 15:181-185, 1982. In Bombay, tuberculosis accounts for 22.1% of deaths in children aged 2 to 5 years, and neurotuberculosis is the cause of between 1.9% and 4.4% of paediatric hospital admissions. Out of 132 children with tuberculous meningitis, 50 developed hydrocephalus. Children who failed to respond to medical treatment or who had a rise in intracranial pressure, had ventriculography and early shunting. A high percentage showed considerable improvement in their neurological status.--RCM Cook Emergency Intracranial Pressure Monitoring in Pediatrics.
T. Mayer and M. L. Walker. Clin Pediatr 21:391-396, (July), 1982. Fifty-six patients with evidence of severe neurologic compromise (Glasco Coma Scale of 7 or less or inability to utter words or follow commands) underwent subarachnoid or intraventricular intracranial-pressure monitoring at the Inter Mountain Trauma Intensive Care Unit of the Primary Children's Medical Center. Diagnoses were head trauma, Reye's Syndrome, and hypoxic encephalopathy due to near drowning. All patients were treated with endotracheal intubation, hyperventilation, and intravenous dexamethasone. After CT scanning, patients with mass lesions were taken directly to the operating room for decompression while the remaining patients underwent intracranial-pressure monitoring immediately with placement of the bolt or catheter in the emergency room or intensive care unit. All patients were treated with methicillin sodium and ampicillin for the duration of monitoring. Eighty percent of the patients had intraeranialpressure elevations requiring treatment. The overall complication rate of intracranial-pressure monitoring was 5.3%; no serious complications were noted. The overall mortality in this group of patients was 14% but patients with hypoxic encephalopathy had significantly higher mortality (33%) compared to patients with head trauma (12.5%) or Reye's Syndrome (10%). Early diagnosis and aggressive treatment in these patients, including the use of intracranial-pressure monitoring, resulted in acceptable recovery in over 85% of these patients.--Richard J. Andrassy
NEOPLASMA Surgical Experience with Retrogastric end Retropancreatic Pheochromocytomas. H. W. Scott, Jr., R. H. Dean, J. W.
Lea IV, et al. Surgery 92:853-865, (November), 1982. Seven patients with retrogastric or retropancreatic pheochromocytomas are reported. Each of these tumors arose between the aorta and the inferior vena tara. Among these patients, one was age 14 and had episodic hypertension. After thorough evaluation, including CT scan and aortography, a mass in the right-adrenal area was localized. At operation, a right-adrenal pheochromocytoma was removed. However, despite preoperative alpha and beta blockade, the patient remained hypertensive and subsequent inferior vena caval venous sampling suggested a tumor at the level of the second lumbar vertebra. Subtraction films made of the previous
527
aortogram revealed an extra-adrenal second pheochromocytoma at the level of L2 in the midline. A subsequent operation removed this tumor which was not palpable until the duodenum was Kocherized. Recovery was uneventful. This report details the difficulties in localizing preoperatively and intraoperatively, smaller tumors in these unusual locations. The authors' experience suggests that small midline pheochromocytomas in these sites may be readily missed by CT, aortography, or surgical search at laparotomy unless subtraction arteriograms are used and the Kocher maneuver is routinely employed.--Eugene S. Wiener Nervous System Specific Enolase INSE): A New Tumor Marker for Neuroblastoma. Y. lshiguro, T. /to, M. Nagaya,
et al. J Jap Soc Pediatr Surg 18:1303-1309, (December), 1982. The authors measured serum levels of nervous system specific enolase (NSE) in 20 healthy adults, 20 infants and children having no malignancy, and 13 patients with neuroblastoma or ganglioneuroblastoma. Measurements were carried out with a sensitive solid-phase sandwich-enzyme immunoassay system, using a monospecific antibody to the gamma subunit of rat NSE for solid-phase preparation and for enzyme-labeled antibody. Serum NSE levels were 2.87 _+ 1.18 ng/mL in normal adults and 5.76 • 2.42 ng/mL in infants and children with no malignancy. Serum NSE levels in patients with neuroblastoma or ganglioneuroblastoma ranged from 6.2 to 230 with a mean of 103.8 _+ 108.0 ng/mL. Serum NSE levels in patients with neuroblastoma or ganglioneuroblastoma were above 10 ng/mL in 10 of 13 patients. These results suggest that the serum NSE could be used as a valuable tumor marker for the screening and therapeutic monitoring of neuroblastoma.--H. Suzuki Hepatic Resection for Secondary Neoplasms. C. E. Morrow,
T. B. Grage, D. E. R. Sutherland, el al. Surgery 92:610-614, (October), 1982. Hepatic resection for metastatic disease was performed in 64 patients with a cumulative survival rate of 45% at 2 years and 34% at 5 years. Single metastatic liver lesions were found in 46 patients (72%) and multiple lesions were found in 18 patients (28%). Lesions were resected from both the left and right side of the liver in seven patients. The operative procedures included 37 wedge resections, 20 segmentectomies, 16 lobectomies, and 2 total hepatectomies in preparation for liver transplantation. The operative mortality rate was 30%. The four patients with Wilm's tumors demonstrated the best 2-year (80%) and 5-year (50%) survival. Thirty patients (47%) with synchronous resections of the primary tumor and the hepatic metastases had a 2- and 5-year survival rate of 29% and 26% whereas 34 patients (53%) with metachronous resections had survival rates of 64% and 30% (P < 0.05). Eighteen patients underwent resection of multiple hepatic lesions with a survival rate essentially no worse than that of patients with isolated metastases (31% versus 18% respectively). The extent of the hepatic resection was primarily dictated by location and number. More extensive resections were not associated with a higher long-term survival rate but did have a higher operative mortality. The authors concluded